Healthcare Provider Details

I. General information

NPI: 1770791873
Provider Name (Legal Business Name): BRIAN C OLBY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 MANIZAKS AVE
PUNTA GORDA FL
33983-4223
US

IV. Provider business mailing address

56 MANIZAKS AVE
PUNTA GORDA FL
33983-4223
US

V. Phone/Fax

Practice location:
  • Phone: 941-204-0059
  • Fax:
Mailing address:
  • Phone: 941-204-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 6434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: