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General NPI Number Information
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NPI Number | 1275033748
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Entity Type | Individual
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Provider Name | ANDREW OLSON RBT
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Gender | Male
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 1630 E SHAW AVE STE 190
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City | FRESNO
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State | CA
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Zip | 93710
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Country | US
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Telephone | 559-475-7860
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Fax | 559-570-0222
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Provider Business Mailing Address
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Address Line | 5132 N PALM AVE
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City | FRESNO
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State | CA
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Zip | 93704-2236
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Country | US
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Telephone | 559-492-7900
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Fax | 559-570-0222
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-43833
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-17-44014
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License Number State | CA
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