Provider Demographics
NPI:1295211100
Name:BROWN, OLIVIA (PEER SUPPORT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 CITY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3325
Mailing Address - Country:US
Mailing Address - Phone:971-600-8027
Mailing Address - Fax:
Practice Address - Street 1:1195 CITY VIEW ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3325
Practice Address - Country:US
Practice Address - Phone:971-600-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000002587175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist