Provider Demographics
NPI:1124816343
Name:AGBELEMOSE, OLUTIMMI A (PSYD)
Entity type:Individual
Prefix:DR
First Name:OLUTIMMI
Middle Name:A
Last Name:AGBELEMOSE
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 DOVE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2852
Mailing Address - Country:US
Mailing Address - Phone:949-706-4889
Mailing Address - Fax:
Practice Address - Street 1:1151 DOVE ST STE 130
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2852
Practice Address - Country:US
Practice Address - Phone:949-706-4889
Practice Address - Fax:949-258-7799
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor