Provider Demographics
NPI:1558551796
Name:OLIVAREZ, MADELINA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MADELINA
Middle Name:
Last Name:OLIVAREZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0011
Mailing Address - Country:US
Mailing Address - Phone:956-490-9905
Mailing Address - Fax:956-424-3190
Practice Address - Street 1:9615 N STEWART RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-6010
Practice Address - Country:US
Practice Address - Phone:956-490-9905
Practice Address - Fax:956-424-3190
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional