Provider Demographics
NPI:1639369341
Name:PISCHEDDA, OLGA CARMEN ELISE (LPC)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:CARMEN ELISE
Last Name:PISCHEDDA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S CZECH HALL RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6851
Mailing Address - Country:US
Mailing Address - Phone:405-492-1113
Mailing Address - Fax:
Practice Address - Street 1:13301 N MERIDIAN STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-752-9500
Practice Address - Fax:405-752-9571
Is Sole Proprietor?:No
Enumeration Date:2007-07-29
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK6042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200531980AMedicaid