Healthcare Provider Details

I. General information

NPI: 1093099459
Provider Name (Legal Business Name): BELINDA OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 CUMMINS DR
MODESTO CA
95358-6400
US

IV. Provider business mailing address

1620 CUMMINS DR
MODESTO CA
95358-6400
US

V. Phone/Fax

Practice location:
  • Phone: 209-622-1420
  • Fax:
Mailing address:
  • Phone: 209-622-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPT 30322
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number87851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: