Provider Demographics
NPI:1750828745
Name:OLIVER, MYSHIRA (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:MYSHIRA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:MYSHIRA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8303 PLATT RD
Mailing Address - Street 2:PO BOX 112
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-0112
Mailing Address - Country:US
Mailing Address - Phone:734-623-9713
Mailing Address - Fax:
Practice Address - Street 1:8303 PLATT RD
Practice Address - Street 2:PO BOX 112
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-0112
Practice Address - Country:US
Practice Address - Phone:734-295-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103T00000X
247200000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other