Healthcare Provider Details

I. General information

NPI: 1336155852
Provider Name (Legal Business Name): KURT H OLSEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COMMERCE PARK DR SUITE 110
WILLIAMSPORT PA
17701-5475
US

IV. Provider business mailing address

320 HIGHLAND DR
MOUNTVILLE PA
17554-1232
US

V. Phone/Fax

Practice location:
  • Phone: 570-323-6944
  • Fax: 570-323-4529
Mailing address:
  • Phone: 717-285-7121
  • Fax: 717-285-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS007889L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: