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Individual

JERRY WAYNE OLIVE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
301 SOVEREIGN CT, SUITE 105, BALLWIN, MO 63011-4441
(636) 448-5184
Mailing address
301 SOVEREIGN CT, SUITE 105, BALLWIN, MO 63011-4441
(636) 448-5184

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2009012865
MO

Other

Enumeration date
02/16/2012
Last updated
02/16/2012
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