Healthcare Provider Details

I. General information

NPI: 1811261647
Provider Name (Legal Business Name): CRAIG D. OLSON PSY.D. & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7071 CORPORATE WAY SUITE 106
CENTERVILLE OH
45459
US

IV. Provider business mailing address

PO BOX 751371
DAYTON OH
45475-1371
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-5999
  • Fax: 937-530-2304
Mailing address:
  • Phone: 937-436-5999
  • Fax: 937-435-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4487
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4487
License Number StateOH

VIII. Authorized Official

Name: DR. CRAIG DOUGLAS OLSON
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 937-436-5999