Active NPI
Charles Lee Olliff, M.ED.,LPC
- Professional Counselor
- Beaumont, TX
National Provider Identifier
1477562056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 15662
- Practice address
- 415 S 11TH St
Beaumont, TX 77701-3834 - Phone
- (409) 813-1116
- Fax
- (409) 813-1116
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 15662 | TX | Primary |
Addresses
Primary practice location
415 S 11TH St
Beaumont, TX 77701-3834
Mailing address
415 S 11TH St
Beaumont, TX 77701-3834
Phone (409) 813-1116
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 096045204 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15662 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325808000000",
"number": "1477562056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 S 11TH ST",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777013834",
"telephone_number": "409-813-1116",
"fax_number": "409-813-1116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 S 11TH ST",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777013834",
"telephone_number": "409-813-1116",
"fax_number": "409-813-1116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLLIFF",
"first_name": "CHARLES",
"middle_name": "LEE",
"credential": "M.ED.,LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2012-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "15662",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "096045204",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.