Healthcare Provider Details

I. General information

NPI: 1780774943
Provider Name (Legal Business Name): CRAIG DOUGLAS OLSON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7071 CORPORATE WAY 7071 CORPORATE WAY SUITE106
CENTERVILLE FINANCE OH
45459-8911
US

IV. Provider business mailing address

2765 HARLAN RD
WAYNESVILLE OH
45068-8768
US

V. Phone/Fax

Practice location:
  • Phone: 937-890-9804
  • Fax: 513-897-3821
Mailing address:
  • Phone: 937-890-9804
  • Fax: 513-897-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4487
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: