Provider Demographics
NPI:1235646787
Name:OLIVER, CINDY ANN (LCPC, LAC)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:ANN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:MT
Mailing Address - Zip Code:59632-0972
Mailing Address - Country:US
Mailing Address - Phone:406-498-5773
Mailing Address - Fax:406-422-4352
Practice Address - Street 1:15 LONE TREE LOOP
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:MT
Practice Address - Zip Code:59632-7641
Practice Address - Country:US
Practice Address - Phone:406-498-5773
Practice Address - Fax:406-422-4352
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-55373101YM0800X
MTBBH-LCPC-LIC-70412101YP2500X
MTBBH-LAC-LIC-1376101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional