Provider Demographics
NPI:1518700020
Name:OLIVER, BRIANNA ODELIA
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ODELIA
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6978 S RIVERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2486
Mailing Address - Country:US
Mailing Address - Phone:720-514-3817
Mailing Address - Fax:
Practice Address - Street 1:4284 TRAIL BOSS DR STE 110
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7521
Practice Address - Country:US
Practice Address - Phone:720-514-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBACB1113212106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician