Provider Demographics
NPI:1073906871
Name:OLIVARES, SCARLETT (MHC)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11932 FAIRWAY LAKES DR STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8337
Mailing Address - Country:US
Mailing Address - Phone:239-237-2801
Mailing Address - Fax:239-771-8327
Practice Address - Street 1:11932 FAIRWAY LAKES DR STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8337
Practice Address - Country:US
Practice Address - Phone:239-237-2801
Practice Address - Fax:239-771-8327
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health