Provider Demographics
NPI:1396769261
Name:OLIVER, JAMIE RAY (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:RAY
Last Name:OLIVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12593 RESEARCH BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2249
Mailing Address - Country:US
Mailing Address - Phone:512-249-0123
Mailing Address - Fax:512-249-9350
Practice Address - Street 1:12593 RESEARCH BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2249
Practice Address - Country:US
Practice Address - Phone:512-249-0123
Practice Address - Fax:512-249-9350
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX061511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical