Provider Demographics
NPI:1689057788
Name:OLIVER, JEFFREY RYAN (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RYAN
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:146 S THOMAS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5328
Mailing Address - Country:US
Mailing Address - Phone:662-840-0974
Mailing Address - Fax:662-840-0388
Practice Address - Street 1:146 S THOMAS ST
Practice Address - Street 2:SUITE C
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5328
Practice Address - Country:US
Practice Address - Phone:662-840-0974
Practice Address - Fax:662-840-0388
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst