Provider Demographics
NPI:1174117782
Name:OLIVER, INDIGO PAIGE (LPC)
Entity type:Individual
Prefix:
First Name:INDIGO
Middle Name:PAIGE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-3407
Mailing Address - Country:US
Mailing Address - Phone:405-694-5894
Mailing Address - Fax:
Practice Address - Street 1:10948 NW EXPRESSWAY STE 13
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8787
Practice Address - Country:US
Practice Address - Phone:405-694-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional