Healthcare Provider Details

I. General information

NPI: 1780097253
Provider Name (Legal Business Name): JENNIFER ANNE OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 COMMON ST
LAKE CHARLES LA
70601-5255
US

IV. Provider business mailing address

1333 COMMON ST
LAKE CHARLES LA
70601-5255
US

V. Phone/Fax

Practice location:
  • Phone: 337-437-4014
  • Fax:
Mailing address:
  • Phone: 337-437-4014
  • Fax: 855-239-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number100138
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8561
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: