Provider Demographics
NPI:1588233720
Name:OLIVARES, REBECCA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-3807
Mailing Address - Country:US
Mailing Address - Phone:214-728-3463
Mailing Address - Fax:
Practice Address - Street 1:5522 LONE STAR PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6719
Practice Address - Country:US
Practice Address - Phone:210-614-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103327104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker