Basic Information
| Provider Information | |||||||||
| NPI: | 1740929595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVO | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | SHEREE | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | OLIVO | ||||||||
| OtherFirstName: | NATALIE | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6042 GEORGETOWN RD APT B | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462541227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197188110 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5638 PROFESSIONAL CIR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462415042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887141927 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2022 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.