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NPI Code Detail

MEDICARE: IVY OLIVER

MEDICARE: IVY OLIVER
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
1101YM0800XMental Health Counselor62818TX

General Provider Information

NPI Number : 1225224058
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVY OLIVER
Provider Business Mailing Address
First Line : 1524 S IH 35 STE 210
Second Line :
City : AUSTIN
State : TX
Zip : 78704-2603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1524 S IH 35 STE 210
Second Line :
City : AUSTIN
State : TX
Zip : 78704-2603
Country : US
Telephone Number : 512-343-8606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2007
Last Update Date : 09/14/2007

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1306363932 — MR. CHARLES P HEGSTROM M.A.
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Directions to “ IVY OLIVER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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