Provider Demographics
NPI:1245669928
Name:OLIVER, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5070 HARRISON DR
Mailing Address - Street 2:STE 116
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-1096
Mailing Address - Country:US
Mailing Address - Phone:702-762-5608
Mailing Address - Fax:
Practice Address - Street 1:5070 HARRISON DR UNIT 116
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-1098
Practice Address - Country:US
Practice Address - Phone:702-762-5608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst