Healthcare Provider Details

I. General information

NPI: 1215642525
Provider Name (Legal Business Name): ASHLEY OLIPHANT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W MOCKINGBIRD LN
DALLAS TX
75247-4931
US

IV. Provider business mailing address

1267 HARLANDALE AVE
DALLAS TX
75216-1124
US

V. Phone/Fax

Practice location:
  • Phone: 469-983-1300
  • Fax:
Mailing address:
  • Phone: 214-693-0312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number105118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: