Healthcare Provider Details

I. General information

NPI: 1477272912
Provider Name (Legal Business Name): JILLIAN OLSON COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 N 113TH PLZ APT 6423
OMAHA NE
68154-5861
US

IV. Provider business mailing address

1408 N 113TH PLZ APT 6423
OMAHA NE
68154-5861
US

V. Phone/Fax

Practice location:
  • Phone: 757-709-1437
  • Fax:
Mailing address:
  • Phone: 757-709-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN E OLSON
Title or Position: INDEPENDENT MENTAL HEALTH PRACITION
Credential: LIMHP, LDAC
Phone: 757-709-1437