Provider Demographics
NPI:1205263308
Name:OLIPHANT CONSULTING, INC.
Entity type:Organization
Organization Name:OLIPHANT CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIPHANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-924-2133
Mailing Address - Street 1:143 CADYCENTRE
Mailing Address - Street 2:206
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1119
Mailing Address - Country:US
Mailing Address - Phone:248-924-2133
Mailing Address - Fax:248-924-2599
Practice Address - Street 1:725 S ADAMS RD
Practice Address - Street 2:SUITE 241
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6902
Practice Address - Country:US
Practice Address - Phone:248-924-2133
Practice Address - Fax:248-924-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005964103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F30377OtherBLUE CROSS BLUE SHIELD
MI3045752OtherCIGNA
MI0P60180OtherMEDICARE PTAN