Healthcare Provider Details

I. General information

NPI: 1457505174
Provider Name (Legal Business Name): SCOTT RONALD OLSON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 HIGHLAND AVE
SALEM MA
01970-2141
US

IV. Provider business mailing address

34 RANTOUL ST UNIT 2
BEVERLY MA
01915-5006
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-2700
  • Fax:
Mailing address:
  • Phone: 978-969-2785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8032
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: