Provider Demographics
NPI:1326554049
Name:OLIVER, MARJORIE P (LAC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:P
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29875 W 339TH ST
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-4159
Mailing Address - Country:US
Mailing Address - Phone:913-755-4357
Mailing Address - Fax:
Practice Address - Street 1:29875 W 339TH ST
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-4159
Practice Address - Country:US
Practice Address - Phone:913-755-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS603101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)