Provider Demographics
NPI:1154680676
Name:OLIVER, CANDEETA JOY
Entity type:Individual
Prefix:
First Name:CANDEETA
Middle Name:JOY
Last Name:OLIVER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CANDEETA
Other - Middle Name:JOY
Other - Last Name:EMBREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1804 COMICE DR
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-6267
Mailing Address - Country:US
Mailing Address - Phone:572-363-1694
Mailing Address - Fax:
Practice Address - Street 1:1804 COMICE DR
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6267
Practice Address - Country:US
Practice Address - Phone:723-631-6945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK05099101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200494290BMedicaid
OK200494290AMedicaid