Healthcare Provider Details

I. General information

NPI: 1912481078
Provider Name (Legal Business Name): JADE OLIVE CRIVEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5703 BAY RD
SAGINAW MI
48604-2507
US

IV. Provider business mailing address

5703 BAY RD
SAGINAW MI
48604-2507
US

V. Phone/Fax

Practice location:
  • Phone: 231-668-4909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: