Provider Demographics
NPI:1942831367
Name:OLIVER PYTON, THELMA (BHTCM)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:
Last Name:OLIVER PYTON
Suffix:
Gender:F
Credentials:BHTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 SW 37TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2740
Mailing Address - Country:US
Mailing Address - Phone:786-431-5793
Mailing Address - Fax:
Practice Address - Street 1:2780 SW 37TH AVENUE
Practice Address - Street 2:SUITE 206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133
Practice Address - Country:US
Practice Address - Phone:305-646-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0Medicaid