Provider Demographics
NPI:1881701613
Name:VIDAL, OLGA J (LPC)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:J
Last Name:VIDAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 MELISSA OAKS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-7965
Mailing Address - Country:US
Mailing Address - Phone:512-636-9436
Mailing Address - Fax:
Practice Address - Street 1:3518 FM 973
Practice Address - Street 2:
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617-3627
Practice Address - Country:US
Practice Address - Phone:512-247-4746
Practice Address - Fax:512-247-2447
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17141101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor