Provider Demographics
NPI:1588153019
Name:OLIVER, ISABEL (LPC-INTERN)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:ISABEL
Other - Middle Name:
Other - Last Name:POORSHAYGAN-OLIVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-INTERN
Mailing Address - Street 1:1401 N CENTRAL EXPY STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 N CENTRAL EXPY STE 105
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4669
Practice Address - Country:US
Practice Address - Phone:214-229-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74469OtherTEXAS STATE BOARD OF PROFESSIONAL COUNSELORS
NAOtherNA