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NPI Code Detail

MEDICARE: THERESA OLSEN M.A.

MEDICARE: THERESA OLSEN M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1457656464
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA OLSEN M.A.
Provider Business Mailing Address
First Line : 3763 STERLING WOODS DR
Second Line :
City : EUGENE
State : OR
Zip : 97408-7200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 687 CHESHIRE AVE
Second Line :
City : EUGENE
State : OR
Zip : 97402-5060
Country : US
Telephone Number : 541-343-2993
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2011
Last Update Date : 01/22/2011

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