Provider Demographics
NPI:1801343082
Name:OLIVER, ELYSIA (LPC, LCPC)
Entity type:Individual
Prefix:
First Name:ELYSIA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SW 13TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3442
Mailing Address - Country:US
Mailing Address - Phone:541-640-3031
Mailing Address - Fax:541-550-1459
Practice Address - Street 1:516 SW 13TH ST STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3442
Practice Address - Country:US
Practice Address - Phone:541-640-3031
Practice Address - Fax:541-550-1459
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC7673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health