MEDICARE: MS. GAIL ANN OLSON PHD, LIMHP,LDAC

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
1	101Y00000X	Counselor	1165	NE
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	184	NE
3	101YM0800X	Mental Health Counselor	263	NE
4	101YP2500X	Professional Counselor	683	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68-0519414	OTHER	NE	FEDERAL TAX ID

General Provider Information

NPI Number	:	1578666194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL ANN OLSON PHD, LIMHP,LDAC

Provider Business Mailing Address
First Line	:	4808 N 170TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-3171
Country	:	US
Telephone Number	:	402-214-4837
Fax Number	:

Provider Business Practice Location Address
First Line	:	13057 W CENTER RD
Second Line	:	SUITE 25
City	:	OMAHA
State	:	NE
Zip	:	68144-3748
Country	:	US
Telephone Number	:	402-214-4837
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	01/23/2009

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