Healthcare Provider Details

I. General information

NPI: 1801186960
Provider Name (Legal Business Name): OLGA M IDRISSI M.ED., LMHC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 VENETIAN DR
BOYNTON BEACH FL
33426-7475
US

IV. Provider business mailing address

2615 VENETIAN DR
BOYNTON BEACH FL
33426-7475
US

V. Phone/Fax

Practice location:
  • Phone: 561-985-6200
  • Fax:
Mailing address:
  • Phone: 561-985-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00114821
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: