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General NPI Number Information
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NPI Number | 1790403921
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Entity Type | Individual
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Provider Name | LISA OLIVER M. ED, PLCP, NCC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 14137 CLAYTON RD
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63017-8355
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Country | US
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Telephone | 314-246-9630
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Fax |
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Provider Business Mailing Address
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Address Line | 1223 SHOREWINDS TRL
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City | SAINT CHARLES
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State | MO
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Zip | 63303-4833
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Country | US
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Telephone | 614-746-9916
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2022028925
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License Number State | MO
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