Provider Demographics
NPI:1790403921
Name:OLIVER, LISA (M ED, PLCP, NCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:M ED, PLCP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 SHOREWINDS TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4833
Mailing Address - Country:US
Mailing Address - Phone:614-746-9916
Mailing Address - Fax:
Practice Address - Street 1:14137 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-8355
Practice Address - Country:US
Practice Address - Phone:314-246-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022028925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health