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General NPI Number Information
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NPI Number | 1639995939
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Entity Type | Individual
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Provider Name | PHILYCIA S OLIVER CADC-I
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Gender | Female
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 6048 S DURANGO DR STE 115
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City | LAS VEGAS
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State | NV
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Zip | 89113-1781
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Country | US
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Telephone | 702-815-1554
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Fax |
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Provider Business Mailing Address
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Address Line | 810 KANSAS ST
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City | PAHRUMP
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State | NV
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Zip | 89048-8293
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Country | US
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Telephone | 775-513-2779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 07913-I
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License Number State | NV
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