Provider Demographics
NPI:1154680676
Name:OLIVER, CANDEETA JOY
Entity Type:Individual
Prefix:
First Name:CANDEETA
Middle Name:JOY
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDEETA
Other - Middle Name:JOY
Other - Last Name:EMBREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:703 NE 21ST TER
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-6170
Mailing Address - Country:US
Mailing Address - Phone:405-551-0794
Mailing Address - Fax:
Practice Address - Street 1:703 NE 21ST TER
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6170
Practice Address - Country:US
Practice Address - Phone:405-551-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200494290AMedicaid
OK200494290BMedicaid