Provider Demographics
NPI:1639662661
Name:OLIVAS, ADAM HECTOR
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:HECTOR
Last Name:OLIVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11848 CHELITA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6138
Mailing Address - Country:US
Mailing Address - Phone:915-249-5882
Mailing Address - Fax:
Practice Address - Street 1:11848 CHELITA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6138
Practice Address - Country:US
Practice Address - Phone:915-249-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician