Healthcare Provider Details

I. General information

NPI: 1144493248
Provider Name (Legal Business Name): NEAL H. OLSHAN, PHD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 E CHOLLA ST
PHOENIX AZ
85028-2304
US

IV. Provider business mailing address

4720 E CHOLLA ST
PHOENIX AZ
85028-2304
US

V. Phone/Fax

Practice location:
  • Phone: 602-705-1144
  • Fax: 480-553-8678
Mailing address:
  • Phone: 602-705-1144
  • Fax: 480-553-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number429
License Number StateAZ

VIII. Authorized Official

Name: DR. NEAL HUGH OLSHAN
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 448-556-9903