Provider Demographics
NPI:1033329107
Name:OLIVAS-HOLGUIN, JANA (LISW)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:
Last Name:OLIVAS-HOLGUIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 E. HOLLY DR.
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005
Mailing Address - Country:US
Mailing Address - Phone:575-386-5986
Mailing Address - Fax:575-556-9456
Practice Address - Street 1:715 E IDAHO AVE STE 2E
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001
Practice Address - Country:US
Practice Address - Phone:575-556-9585
Practice Address - Fax:575-556-9456
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-068651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM20-2612295OtherTAX ID