Healthcare Provider Details

I. General information

NPI: 1871714402
Provider Name (Legal Business Name): ELIZABETH OLIVARES-REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 CHIMNEY ROCK RD SUITE Y
HOUSTON TX
77081-2706
US

IV. Provider business mailing address

PO BOX 841969
DALLAS TX
75284-1969
US

V. Phone/Fax

Practice location:
  • Phone: 713-661-2951
  • Fax:
Mailing address:
  • Phone: 832-824-2999
  • Fax: 832-825-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number36161
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: