Provider Demographics
NPI:1770799967
Name:OLIVER, SHELLY JEANNE (LCSW)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:JEANNE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 ORLANDO RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-2553
Mailing Address - Country:US
Mailing Address - Phone:512-263-4165
Mailing Address - Fax:
Practice Address - Street 1:5524 BEE CAVES RD STE G2
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5246
Practice Address - Country:US
Practice Address - Phone:512-663-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical