Provider Demographics
NPI:1548889017
Name:OLVERA, GREYDI
Entity type:Individual
Prefix:
First Name:GREYDI
Middle Name:
Last Name:OLVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GREYDI
Other - Middle Name:
Other - Last Name:OLVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3415 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3371
Mailing Address - Country:US
Mailing Address - Phone:503-234-9591
Mailing Address - Fax:
Practice Address - Street 1:CHILDRENS FARM HOME 4455 NE HWY 20
Practice Address - Street 2:
Practice Address - City:CORVALLIUS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-757-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health