Healthcare Provider Details

I. General information

NPI: 1245864867
Provider Name (Legal Business Name): BRIE-JANAE LYNN OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 K ST
CRESCENT CITY CA
95531-4107
US

IV. Provider business mailing address

455 K ST
CRESCENT CITY CA
95531-4107
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-7224
  • Fax:
Mailing address:
  • Phone: 707-464-7224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: