Provider Demographics
NPI:1720798929
Name:OLIVAREZ, ROY JR
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:OLIVAREZ
Suffix:JR
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 1:1813 FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5774
Mailing Address - Country:US
Mailing Address - Phone:956-460-9775
Mailing Address - Fax:
Practice Address - Street 1:1813 FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5774
Practice Address - Country:US
Practice Address - Phone:956-460-9775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health