Healthcare Provider Details

I. General information

NPI: 1306356050
Provider Name (Legal Business Name): BENJAMIN K OLSON MA, LPC, QMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1869 N 1120 W
PROVO UT
84604-1180
US

IV. Provider business mailing address

6310 NAAMAN FOREST BLVD SUITE 1401
GARLAND TX
75044
US

V. Phone/Fax

Practice location:
  • Phone: 503-884-7422
  • Fax:
Mailing address:
  • Phone: 503-884-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14295646-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number102088
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8224
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: