Provider Demographics
NPI:1508951914
Name:OLLEROS, MAYDA OLIVIA (M ED LPC)
Entity Type:Individual
Prefix:MS
First Name:MAYDA
Middle Name:OLIVIA
Last Name:OLLEROS
Suffix:
Gender:F
Credentials:M ED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 E. LOS EBANOS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520
Mailing Address - Country:US
Mailing Address - Phone:956-541-8040
Mailing Address - Fax:
Practice Address - Street 1:905 E. LOS EBANOS BLVD
Practice Address - Street 2:STE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-541-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116832OtherSUPERIOR HEALTH PLAN
TX8257OLOtherBCBS