Provider Demographics
NPI:1568694214
Name:OLIVER, NATHANIEL PHILLIP (MA, LPC)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:PHILLIP
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5099 E BLUE LUPINE DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8426
Mailing Address - Country:US
Mailing Address - Phone:907-201-0177
Mailing Address - Fax:
Practice Address - Street 1:5099 E BLUE LUPINE DR
Practice Address - Street 2:SUITE 212
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8426
Practice Address - Country:US
Practice Address - Phone:907-201-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0501343101YP2500X
AK649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional