Provider Demographics
NPI:1467127225
Name:OLIVIA WEDEL COUNSELING & CONSULTING, PLLC
Entity Type:Organization
Organization Name:OLIVIA WEDEL COUNSELING & CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, NCC, LCDC
Authorized Official - Phone:817-721-9570
Mailing Address - Street 1:603 BAYLESS DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-5101
Mailing Address - Country:US
Mailing Address - Phone:817-721-9570
Mailing Address - Fax:
Practice Address - Street 1:409 W WALL ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5203
Practice Address - Country:US
Practice Address - Phone:817-264-6604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356758718Medicaid