Healthcare Provider Details

I. General information

NPI: 1346046307
Provider Name (Legal Business Name): DESTINY RENEE OLVERA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 HONDO PASS DR # 1D3085
EL PASO TX
79904-1474
US

IV. Provider business mailing address

4717 HONDO PASS DR # 1D3085
EL PASO TX
79904-1474
US

V. Phone/Fax

Practice location:
  • Phone: 915-229-4498
  • Fax:
Mailing address:
  • Phone: 915-229-4498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0070
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: