Healthcare Provider Details

I. General information

NPI: 1144994146
Provider Name (Legal Business Name): MIKKI MARIE OLSSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 JEFFERSON ST
MANSFIELD LA
71052-2602
US

IV. Provider business mailing address

PO BOX 1636
MANSFIELD LA
71052-1636
US

V. Phone/Fax

Practice location:
  • Phone: 318-872-2700
  • Fax: 318-872-6214
Mailing address:
  • Phone: 318-270-3265
  • Fax: 318-270-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5133
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: