Provider Demographics
NPI:1518984368
Name:OLINGER, JEAN L (DM, LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:OLINGER
Suffix:
Gender:F
Credentials:DM, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 BLUFF RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-4812
Mailing Address - Country:US
Mailing Address - Phone:940-235-0407
Mailing Address - Fax:830-833-1381
Practice Address - Street 1:703 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606
Practice Address - Country:US
Practice Address - Phone:830-833-4771
Practice Address - Fax:830-833-1381
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063849601Medicaid
TX532494OtherMEDICARE PTAN