Provider Demographics
NPI:1003615824
Name:OLIVEROS, ANGIE (MFT-I)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:OLIVEROS
Suffix:
Gender:
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 CLIFF SHADOWS PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-1077
Mailing Address - Country:US
Mailing Address - Phone:702-673-4745
Mailing Address - Fax:
Practice Address - Street 1:3455 CLIFF SHADOWS PKWY STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-1077
Practice Address - Country:US
Practice Address - Phone:702-673-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4486106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist