Provider Demographics
NPI:1114697356
Name:MCDONALD, OLIVIA RAYE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:RAYE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 RASOR BLVD STE 231
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-0154
Mailing Address - Country:US
Mailing Address - Phone:214-718-5303
Mailing Address - Fax:
Practice Address - Street 1:8105 RASOR BLVD STE 231
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0154
Practice Address - Country:US
Practice Address - Phone:214-718-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105073104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker