Healthcare Provider Details

I. General information

NPI: 1952649428
Provider Name (Legal Business Name): SUZANNE MARIE OLSON LCADC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 NORTH CT STE 100
GARDNERVILLE NV
89410-5489
US

IV. Provider business mailing address

1558 HIGH POINTE CT
MINDEN NV
89423-9200
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-3671
  • Fax: 775-782-6639
Mailing address:
  • Phone: 530-520-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number481-L
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number01233
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: