Provider Demographics
NPI:1013116193
Name:BIRCHWOOD-GLOVER, OLIVER (LCSW)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:BIRCHWOOD-GLOVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 1/2 E MAIN ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1950
Mailing Address - Country:US
Mailing Address - Phone:509-525-1750
Mailing Address - Fax:509-525-1606
Practice Address - Street 1:409 E SUMACH ST STE 4
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-540-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
COLCSW - 9926491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2010913Medicaid