Healthcare Provider Details

I. General information

NPI: 1912838319
Provider Name (Legal Business Name): KRISTEN OLSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4381 S EASON BLVD STE 201
TUPELO MS
38801-6585
US

IV. Provider business mailing address

4381 S EASON BLVD STE 201
TUPELO MS
38801-6585
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-5199
  • Fax: 662-377-5301
Mailing address:
  • Phone: 662-377-5199
  • Fax: 662-377-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC12002
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: