Healthcare Provider Details

I. General information

NPI: 1548240401
Provider Name (Legal Business Name): RITA KAYE OLSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 TETON PASS
BROOKINGS SD
57006-3626
US

IV. Provider business mailing address

1727 TETON PASS
BROOKINGS SD
57006-3626
US

V. Phone/Fax

Practice location:
  • Phone: 605-692-1614
  • Fax: 605-692-1614
Mailing address:
  • Phone: 605-692-1614
  • Fax: 605-692-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-MH2026
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT1055
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: