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General NPI Number Information
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NPI Number | 1003248584
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Entity Type | Individual
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Provider Name | GREG PATRICK OLSON RRW
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Gender | Male
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 1100 W SHAW AVE STE 122
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City | FRESNO
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State | CA
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Zip | 93711-3708
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Country | US
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Telephone | 559-681-1947
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Fax | 559-412-2126
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Provider Business Mailing Address
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Address Line | 1100 W SHAW AVE STE 122
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City | FRESNO
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State | CA
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Zip | 93711-3708
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Country | US
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Telephone | 559-681-1947
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Fax | 559-412-2126
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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