Provider Demographics
NPI:1629372115
Name:BERKOUT, OLGA VADYMOVNA (PHD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:VADYMOVNA
Last Name:BERKOUT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 COUNTY ROAD 7283
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-5192
Mailing Address - Country:US
Mailing Address - Phone:662-613-0008
Mailing Address - Fax:
Practice Address - Street 1:2935 BAIN PL
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8017
Practice Address - Country:US
Practice Address - Phone:662-613-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37551103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist