Provider Demographics
NPI:1578887113
Name:DANIELS, OLIVIA (BHRS)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 NW 126TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5086
Mailing Address - Country:US
Mailing Address - Phone:405-748-3432
Mailing Address - Fax:
Practice Address - Street 1:1729 W. 33RD STREET
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3836
Practice Address - Country:US
Practice Address - Phone:405-748-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK025365687Medicaid
OK027884943Medicaid
OK006948103Medicaid
OK028638434Medicaid
OK030674055Medicaid
OK0269000324Medicaid