Healthcare Provider Details

I. General information

NPI: 1841028172
Provider Name (Legal Business Name): DONALD OLSEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 ODELL HILL RD
CENTER CONWAY NH
03813-4412
US

IV. Provider business mailing address

281 ODELL HILL RD
CENTER CONWAY NH
03813-4412
US

V. Phone/Fax

Practice location:
  • Phone: 760-532-7321
  • Fax:
Mailing address:
  • Phone: 760-532-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34895
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1696
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1696
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: