Provider Demographics
NPI:1598277766
Name:OLIVER, CAROL LYNNE (MBA, MA, LPC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNNE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MBA, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9666 OLIVE BLVD SUITE 205
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2924
Mailing Address - Country:US
Mailing Address - Phone:314-991-0100
Mailing Address - Fax:
Practice Address - Street 1:10176 CORPORATE SQUARE DR STE OFFICE13
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-991-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017014686101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor