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Organization
SOUL TIDE PSYCHOTHERAPY PC
Active
Organization
SOUL TIDE PSYCHOTHERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR OLSON PSY.D. (SECRETARY)
(858) 945-7421
Entity
Organization
Contact information
Practice address
3257 CAMINO DE LOS COCHES, CARLSBAD, CA 92009-8976
(858) 945-7421
Mailing address
2204 IRVING AVE, SAN DIEGO, CA 92113-2301
(858) 945-7421
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TH0004X
Health Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
—
—
Other
Enumeration date
04/29/2025
Last updated
07/30/2025
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