Provider Demographics
NPI:1417789868
Name:OLIVE, KRISTA R
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:R
Last Name:OLIVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2246
Mailing Address - Country:US
Mailing Address - Phone:513-739-0913
Mailing Address - Fax:
Practice Address - Street 1:659 WAVERLY DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2246
Practice Address - Country:US
Practice Address - Phone:513-739-0913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2405749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health