Provider Demographics
NPI:1821630195
Name:OLIVER, COLTEN J (ABA)
Entity Type:Individual
Prefix:
First Name:COLTEN
Middle Name:J
Last Name:OLIVER
Suffix:
Gender:M
Credentials:ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 S GILBERT RD # 101-103
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2268
Mailing Address - Country:US
Mailing Address - Phone:480-482-5005
Mailing Address - Fax:
Practice Address - Street 1:538 S GILBERT RD # 101-103
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2268
Practice Address - Country:US
Practice Address - Phone:480-482-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-19-37980103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst