Provider Demographics
NPI:1467923490
Name:PIERCE, OLIVIA
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30518 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:OK
Mailing Address - Zip Code:74852-9778
Mailing Address - Country:US
Mailing Address - Phone:405-294-7393
Mailing Address - Fax:
Practice Address - Street 1:6612 NW 42ND ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2764
Practice Address - Country:US
Practice Address - Phone:405-717-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10236OtherSTATE OF OKLAHOMA STATE BOARD OF BEHAVIORAL HEALTH LICENSURE