Provider Demographics
NPI:1922549492
Name:MARISOL OLIVAS LMFT LLC
Entity Type:Organization
Organization Name:MARISOL OLIVAS LMFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAR
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:505-927-8077
Mailing Address - Street 1:5019 KENSINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012
Mailing Address - Country:US
Mailing Address - Phone:505-927-8077
Mailing Address - Fax:
Practice Address - Street 1:5019 KENSINGTON WAY
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012
Practice Address - Country:US
Practice Address - Phone:505-927-8077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0163541251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health