Provider Demographics
NPI:1841435799
Name:OLIVAS, NANCY W (MA, LPCC, LADAC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:W
Last Name:OLIVAS
Suffix:
Gender:F
Credentials:MA, LPCC, LADAC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:W
Other - Last Name:OLIVAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6469 WAGONS EAST TRL
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-6735
Mailing Address - Country:US
Mailing Address - Phone:575-993-9048
Mailing Address - Fax:575-635-4249
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:EXECUTIVE STES #3
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005
Practice Address - Country:US
Practice Address - Phone:575-993-9048
Practice Address - Fax:575-635-4249
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAD3572101YA0400X
NMCCMH0127761101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79989560Medicaid