Provider Demographics
NPI:1942984794
Name:OLISA, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:OLISA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20515 HEATH HOUSE
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-1299
Mailing Address - Country:US
Mailing Address - Phone:281-736-8154
Mailing Address - Fax:
Practice Address - Street 1:20515 HEATH HOUSE
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-1299
Practice Address - Country:US
Practice Address - Phone:281-736-8154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical