Provider Demographics
NPI:1184052201
Name:VALDEZ-MASSENA, OLIVIA (LCPC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:VALDEZ-MASSENA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:MASSENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6324
Mailing Address - Country:US
Mailing Address - Phone:217-525-1064
Mailing Address - Fax:217-525-1651
Practice Address - Street 1:515 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1401
Practice Address - Country:US
Practice Address - Phone:217-735-2272
Practice Address - Fax:217-735-2342
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180008848OtherLCPC LICENSE