Provider Demographics
NPI:1497141295
Name:OLIVER, ELISE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 OLD FAIRMONT PIKE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-4635
Mailing Address - Country:US
Mailing Address - Phone:304-374-6906
Mailing Address - Fax:
Practice Address - Street 1:554 OLD FAIRMONT PIKE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-4635
Practice Address - Country:US
Practice Address - Phone:304-374-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-15-18380OtherBEHAVIOR ANALYST CERTIFICATION BOARD