Provider Demographics
NPI:1023450954
Name:MARTINEZ, OLIVIA LEEANN
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:LEEANN
Last Name:MARTINEZ
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 1:300 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-7527
Mailing Address - Country:US
Mailing Address - Phone:405-657-0291
Mailing Address - Fax:
Practice Address - Street 1:300 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:OK
Practice Address - Zip Code:73049-7527
Practice Address - Country:US
Practice Address - Phone:405-657-0291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health