Provider Demographics
NPI:1447979059
Name:MACIAS, OLGA
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:MACIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N GILA BLVD
Mailing Address - Street 2:
Mailing Address - City:GILA BEND
Mailing Address - State:AZ
Mailing Address - Zip Code:85337-1016
Mailing Address - Country:US
Mailing Address - Phone:877-809-5092
Mailing Address - Fax:623-932-5725
Practice Address - Street 1:100 N GILA BLVD
Practice Address - Street 2:
Practice Address - City:GILA BEND
Practice Address - State:AZ
Practice Address - Zip Code:85337-1016
Practice Address - Country:US
Practice Address - Phone:877-809-5092
Practice Address - Fax:623-932-5725
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician