Individual
MICHAEL TENNIS OLIVER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4579 S EASON BLVD, TUPELO, MS 38801-6539
(662) 377-3161
(662) 377-2993
Mailing address
450 E PRESIDENT AVE, TUPELO, MS 38801-5599
(662) 377-4685
(662) 377-2755
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
25327
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04331003
—
MS
Enumeration date
06/05/2006
Last updated
07/08/2007
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