Provider Demographics
NPI:1386913424
Name:OLIVER, SASHA MONIQUE (BS BHRS)
Entity type:Individual
Prefix:MS
First Name:SASHA
Middle Name:MONIQUE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:BS BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73121-2430
Mailing Address - Country:US
Mailing Address - Phone:405-414-3566
Mailing Address - Fax:
Practice Address - Street 1:3000 N FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73121-2430
Practice Address - Country:US
Practice Address - Phone:405-414-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKW082196158103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation