Provider Demographics
NPI:1699098723
Name:OLIDGE, JAIME TAVONIA (LPC-A)
Entity type:Individual
Prefix:MS
First Name:JAIME
Middle Name:TAVONIA
Last Name:OLIDGE
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 A W GRIMES BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-1979
Mailing Address - Country:US
Mailing Address - Phone:617-379-0496
Mailing Address - Fax:
Practice Address - Street 1:2911 A W GRIMES BLVD STE 330
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-1979
Practice Address - Country:US
Practice Address - Phone:617-379-0496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TX88323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)