=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205697034
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEVIN S OLIN PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2024
-----------------------------------------------------
Last Update Date | 01/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6625 S RURAL RD STE 111
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85283-3717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-345-9888
-----------------------------------------------------
Fax | 480-739-9065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6625 S RURAL RD STE 111
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85283-3717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-345-9888
-----------------------------------------------------
Fax | 480-739-9065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KEVIN S OLIN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 480-720-7488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------