Provider Demographics
NPI:1134470511
Name:GOBBLE, OLIVIA (LCSW)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:GOBBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PURCELL RD
Mailing Address - Street 2:
Mailing Address - City:LEOMA
Mailing Address - State:TN
Mailing Address - Zip Code:38468-5380
Mailing Address - Country:US
Mailing Address - Phone:931-242-4249
Mailing Address - Fax:
Practice Address - Street 1:39 PURCELL RD
Practice Address - Street 2:
Practice Address - City:LEOMA
Practice Address - State:TN
Practice Address - Zip Code:38468-5380
Practice Address - Country:US
Practice Address - Phone:931-242-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1041S0200X, 1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator