=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114237997
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN L. OLSON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2010
-----------------------------------------------------
Last Update Date | 06/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74710 HIGHWAY 111 STE 102
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-839-8199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73950 ZIRCON CIR W
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-2274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-533-0637
-----------------------------------------------------
Fax | 760-818-8157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 66515
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------