Provider Demographics
NPI:1942542683
Name:OLIPHANT, EVA J (LPC LICENSED PROFESS)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:J
Last Name:OLIPHANT
Suffix:
Gender:F
Credentials:LPC LICENSED PROFESS
Other - Prefix:MRS
Other - First Name:EVA
Other - Middle Name:L
Other - Last Name:OLIPHANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:P.O. BOX 1051
Mailing Address - Street 2:817 MLK
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-1051
Mailing Address - Country:US
Mailing Address - Phone:936-661-4043
Mailing Address - Fax:
Practice Address - Street 1:817 MLK
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-0817
Practice Address - Country:US
Practice Address - Phone:936-661-4043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66998101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional