Provider Demographics
NPI:1083851679
Name:OLVER, KIMBERLY M (LPC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:M
Last Name:OLVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2666
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-8666
Mailing Address - Country:US
Mailing Address - Phone:708-957-6047
Mailing Address - Fax:708-957-8028
Practice Address - Street 1:4131 191ST PL
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-5803
Practice Address - Country:US
Practice Address - Phone:708-957-6047
Practice Address - Fax:708-957-8028
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000806101YP2500X
IL178-003370101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional