Healthcare Provider Details

I. General information

NPI: 1518190420
Provider Name (Legal Business Name): SYLVIA OLNEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYLVIA HEROLD

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 3RD ST NW
BEMIDJI MN
56601-3111
US

IV. Provider business mailing address

223 3RD ST NW
BEMIDJI MN
56601-3111
US

V. Phone/Fax

Practice location:
  • Phone: 218-259-3137
  • Fax:
Mailing address:
  • Phone: 218-259-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1035
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: