Healthcare Provider Details

I. General information

NPI: 1013341130
Provider Name (Legal Business Name): ELANA M OLSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5796 S 900 E
MURRAY UT
84121-1036
US

IV. Provider business mailing address

PO BOX 900954
SANDY UT
84090-0954
US

V. Phone/Fax

Practice location:
  • Phone: 801-717-6428
  • Fax:
Mailing address:
  • Phone: 801-717-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number95233933501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: