Provider Demographics
NPI:1518367135
Name:OLLEARIS, KATHLEEN M (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:OLLEARIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 45TH AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3868
Mailing Address - Country:US
Mailing Address - Phone:219-407-2911
Mailing Address - Fax:
Practice Address - Street 1:1544 45TH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3868
Practice Address - Country:US
Practice Address - Phone:219-407-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002598A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health