Provider Demographics
NPI:1205571346
Name:OLIEL MARQUEZ, SHLOMIT TANIA (LPCA)
Entity type:Individual
Prefix:
First Name:SHLOMIT
Middle Name:TANIA
Last Name:OLIEL MARQUEZ
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1323
Mailing Address - Country:US
Mailing Address - Phone:682-246-2817
Mailing Address - Fax:
Practice Address - Street 1:3740 N JOSEY LN STE 145
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2471
Practice Address - Country:US
Practice Address - Phone:469-701-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health