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NPI Code Detail

MEDICARE: LORI OLIVER LCDC

MEDICARE: LORI OLIVER LCDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor11764TX

General Provider Information

NPI Number : 1114602638
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI OLIVER LCDC
Provider Business Mailing Address
First Line : 803 S RUSK ST
Second Line :
City : AMARILLO
State : TX
Zip : 79106-6648
Country : US
Telephone Number : 806-344-6688
Fax Number :
Provider Business Practice Location Address
First Line : 1001 WALLACE BLVD
Second Line :
City : AMARILLO
State : TX
Zip : 79106-1735
Country : US
Telephone Number : 806-318-7712
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2023
Last Update Date : 06/21/2023

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