=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073827390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN OLIVER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2010
-----------------------------------------------------
Last Update Date | 07/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1321 RESEARCH PARK DR
-----------------------------------------------------
City | BEAVERCREEK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45432-2851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-437-3837
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 452 W MARKET ST
-----------------------------------------------------
City | XENIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45385-2815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-376-8700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 031020
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------