Provider Demographics
NPI:1447846266
Name:OLIVER, KAITLIN COLLEEN OBRIEN (LMHCA,ESA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:COLLEEN OBRIEN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LMHCA,ESA
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:COLLEEN
Other - Last Name:OBRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-0003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15715 MAIN ST NE STE 210
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8580
Practice Address - Country:US
Practice Address - Phone:425-224-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool