Healthcare Provider Details

I. General information

NPI: 1386345916
Provider Name (Legal Business Name): KRISTEN M OLVERA-MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22601 LUTHERAN CHURCH RD
TOMBALL TX
77377-3716
US

IV. Provider business mailing address

27 SPURWOOD CT
THE WOODLANDS TX
77381-3539
US

V. Phone/Fax

Practice location:
  • Phone: 281-203-7456
  • Fax:
Mailing address:
  • Phone: 281-203-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number91114
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: