Provider Demographics
NPI:1164776357
Name:OLEARNICK, EDWARD S
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:OLEARNICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10922 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2703
Mailing Address - Country:US
Mailing Address - Phone:918-709-5600
Mailing Address - Fax:
Practice Address - Street 1:10922 E 39TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2703
Practice Address - Country:US
Practice Address - Phone:918-709-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health