Healthcare Provider Details

I. General information

NPI: 1881723948
Provider Name (Legal Business Name): JEFF N OLSGAARD MA, MDIV, NCC, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NW CIVIC DR SUITE 310
GRESHAM OR
97030-3770
US

IV. Provider business mailing address

PO BOX 13765
PORTLAND OR
97213-0765
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-8832
  • Fax: 503-669-8641
Mailing address:
  • Phone: 971-266-0536
  • Fax: 888-875-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number867 - LCPC
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC C3060
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: