Provider Demographics
NPI:1093446601
Name:ENLOE, OLIVIA (CT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:ENLOE
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 STOW PL
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1643
Mailing Address - Country:US
Mailing Address - Phone:440-855-3410
Mailing Address - Fax:
Practice Address - Street 1:670 MERIDIAN WAY
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7648
Practice Address - Country:US
Practice Address - Phone:614-270-7958
Practice Address - Fax:614-300-5596
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103421-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health