Tyrone Oliver V, M.A

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC004472 Issued in GA

Practice address

2777 Jefferson St
Suite 6 and 8
Austell, GA 30168-4054

Phone

(404) 840-5904

Fax

(708) 613-9661

NPI assigned

Jul 14, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oliver Counseling Service

  • Community/Behavioral Health Agency
  • Austell, GA
  • NPI 1316599566
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468454400000",
    "number": "1083067003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4665 OAKLEIGH MANOR DR",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301274937",
            "telephone_number": "404-840-5904",
            "fax_number": "708-613-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2777 JEFFERSON ST",
            "address_2": "SUITE 6 AND 8",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301684054",
            "telephone_number": "404-840-5904",
            "fax_number": "708-613-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "TYRONE",
        "name_suffix": "V",
        "credential": "M.A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-14",
        "last_updated": "2016-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Austell, GA
• Providers in Austell, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.