Provider Demographics
NPI:1649521436
Name:OLIVER, MICHAEL PHILLIP
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PHILLIP
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 1:4711 NARCISSUS DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-1492
Mailing Address - Country:US
Mailing Address - Phone:615-810-8180
Mailing Address - Fax:
Practice Address - Street 1:4455 ALLEN LN STE 130
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2208
Practice Address - Country:US
Practice Address - Phone:702-385-1072
Practice Address - Fax:702-385-3053
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10161-C1041C0700X
MSC97571041C0700X
TNLSW00000073721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical