Healthcare Provider Details

I. General information

NPI: 1750828745
Provider Name (Legal Business Name): MYSHIRA OLIVER PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYSHIRA JONES

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 PLATT RD PO BOX 112
SALINE MI
48176-0112
US

IV. Provider business mailing address

8303 PLATT RD PO BOX 112
SALINE MI
48176-0112
US

V. Phone/Fax

Practice location:
  • Phone: 734-295-4511
  • Fax:
Mailing address:
  • Phone: 734-623-9713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: