Healthcare Provider Details

I. General information

NPI: 1306505516
Provider Name (Legal Business Name): LATASHA DENISE OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W PARK ROW DR STE A
ARLINGTON TX
76010-2559
US

IV. Provider business mailing address

600 W PARK ROW DR STE A
ARLINGTON TX
76010-2559
US

V. Phone/Fax

Practice location:
  • Phone: 817-987-2651
  • Fax: 214-602-6638
Mailing address:
  • Phone: 817-987-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number69058
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: