Basic Information
| Provider Information | |||||||||
| NPI: | 1750030102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEAN | ||||||||
| FirstName: | OLIVIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6068 PLUMAS ST APT H | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895196034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072925390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 860 TYLER WAY | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894312172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753560371 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2022 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 9679-M | NV | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.