Healthcare Provider Details

I. General information

NPI: 1700089067
Provider Name (Legal Business Name): NECOLE LAYER OLMSTEAD M. A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 06/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HUDSON ST
CAMDENTON MO
65020-6904
US

IV. Provider business mailing address

119 N BENTON ST PO BOX 514
WAYNESVILLE MO
65583-2501
US

V. Phone/Fax

Practice location:
  • Phone: 573-337-0408
  • Fax:
Mailing address:
  • Phone: 573-433-2833
  • Fax: 573-433-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004020356
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: