Basic Information
| Provider Information | |||||||||
| NPI: | 1407402589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | MADELINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6524 W 300 N | ||||||||
| Address2: | |||||||||
| City: | EARL PARK | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479428670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048400940 | ||||||||
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| Practice Location | |||||||||
| Address1: | 833 PARK EAST BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479050785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657434400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2019 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 85000429A | IN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.