Provider Demographics
NPI:1235486168
Name:OLIVES, ADAM (BCBA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:OLIVES
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 SUNRISE BLVD STE 210B
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7639
Mailing Address - Country:US
Mailing Address - Phone:916-794-2326
Mailing Address - Fax:916-626-4682
Practice Address - Street 1:5750 SUNRISE BLVD STE 210B
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610
Practice Address - Country:US
Practice Address - Phone:916-794-2326
Practice Address - Fax:916-626-4682
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1107493103K00000X
CA1-10-7493103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty