Provider Demographics
NPI:1659135903
Name:OLIVARES, DIANA (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14901 E HAMPDEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5037
Mailing Address - Country:US
Mailing Address - Phone:720-260-4115
Mailing Address - Fax:
Practice Address - Street 1:14901 E HAMPDEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5037
Practice Address - Country:US
Practice Address - Phone:720-260-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health