Healthcare Provider Details

I. General information

NPI: 1386285765
Provider Name (Legal Business Name): DANNY J OLMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOE OLMI PH.D.

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 LAKELAND TER
JACKSON MS
39216-4702
US

IV. Provider business mailing address

126 BENT CRK
HATTIESBURG MS
39402-8474
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-7827
  • Fax: 601-822-0303
Mailing address:
  • Phone: 601-270-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number33-526
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: