Basic Information
| Provider Information | |||||||||
| NPI: | 1881757433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVEIRA | ||||||||
| FirstName: | ODACIR | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1999 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377771999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659701295 | ||||||||
| FaxNumber: | 8653801461 | ||||||||
| Practice Location | |||||||||
| Address1: | 2347 JONES BEND RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377775213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659709800 | ||||||||
| FaxNumber: | 8653801461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TA0700X | 606 | TN | Y | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
No ID Information.