MEDICARE: OLIVIA ROSE HUARD LMSW

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	19238	AZ

General Provider Information

NPI Number	:	1851030084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA ROSE HUARD LMSW

Provider Business Mailing Address
First Line	:	3275 RUSTLER DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-4016
Country	:	US
Telephone Number	:	909-533-1181
Fax Number	:

Provider Business Practice Location Address
First Line	:	3275 RUSTLER DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-4016
Country	:	US
Telephone Number	:	909-533-1181
Fax Number	:

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

Provider Enumeration Date	:	06/04/2022
Last Update Date	:	09/02/2025

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