Basic Information
| Provider Information | |||||||||
| NPI: | 1730505975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLVERA | ||||||||
| FirstName: | RICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2105 CAPURRO WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894318518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754205396 | ||||||||
| FaxNumber: | 7754205053 | ||||||||
| Practice Location | |||||||||
| Address1: | 2105 CAPURRO WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894318518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754205396 | ||||||||
| FaxNumber: | 7754205053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2014 | ||||||||
| LastUpdateDate: | 03/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.