Basic Information
| Provider Information | |||||||||
| NPI: | 1982056495 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LILLEY | ||||||||
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| Credential: | M.A., LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711053320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182789867 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3003 KNIGHT ST STE 115 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711052561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182278390 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2016 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.