Provider Demographics
NPI:1740711571
Name:OLIVARES, MARC (MA, MS, LPC-S)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:OLIVARES
Suffix:
Gender:M
Credentials:MA, MS, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 MELLENCAMP DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-2098
Mailing Address - Country:US
Mailing Address - Phone:737-708-7417
Mailing Address - Fax:512-900-2986
Practice Address - Street 1:7909 MELLENCAMP DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-2098
Practice Address - Country:US
Practice Address - Phone:737-708-7417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional