Healthcare Provider Details

I. General information

NPI: 1629104237
Provider Name (Legal Business Name): MARCIA OLMSTED LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 AUSTIN AVE STE. 1103
WACO TX
76701-1902
US

IV. Provider business mailing address

900 AUSTIN AVE STE. 1103
WACO TX
76701-1902
US

V. Phone/Fax

Practice location:
  • Phone: 254-757-1190
  • Fax: 254-757-1150
Mailing address:
  • Phone: 254-757-1190
  • Fax: 254-757-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: