Provider Demographics
NPI:1598496333
Name:BALCOM, OLIVIA (MS)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BALCOM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7433 BRENTCOVE CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1806
Mailing Address - Country:US
Mailing Address - Phone:716-864-9794
Mailing Address - Fax:
Practice Address - Street 1:3410 WORTH ST STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2008
Practice Address - Country:US
Practice Address - Phone:214-818-8473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS