Provider Demographics
NPI:1285174003
Name:DE OLIVEIRA, JEAN PIERRE RYAN
Entity type:Individual
Prefix:
First Name:JEAN PIERRE
Middle Name:RYAN
Last Name:DE OLIVEIRA
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 1:865 LADONNA AVE
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2240
Mailing Address - Country:US
Mailing Address - Phone:817-449-0272
Mailing Address - Fax:
Practice Address - Street 1:865 LADONNA AVE
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2240
Practice Address - Country:US
Practice Address - Phone:817-449-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88646101Y00000X
CA8570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor