Healthcare Provider Details

I. General information

NPI: 1275519688
Provider Name (Legal Business Name): HOWARD OLSEN LPC, LMSW, LM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N BEACH ST
HALTOM CITY TX
76137-3221
US

IV. Provider business mailing address

PO BOX 48675
FT WORTH TX
76148-0675
US

V. Phone/Fax

Practice location:
  • Phone: 817-846-9718
  • Fax:
Mailing address:
  • Phone: 817-846-9718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11962
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: