MEDICARE: VALERIE ALYSSA OLVERA MS

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
1	101YM0800X	Mental Health Counselor	94022	TX

General Provider Information

NPI Number	:	1588347264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE ALYSSA OLVERA MS

Provider Business Mailing Address
First Line	:	331 14TH AVE N
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-6232
Country	:	US
Telephone Number	:	325-227-5489
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 QUEENSDOWN WAY
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-3579
Country	:	US
Telephone Number	:	214-506-8094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/09/2023

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