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General NPI Number Information
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NPI Number | 1548853633
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Entity Type | Individual
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Provider Name | JASON TODD OLIN PHD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 4100 CAMPUS DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1934
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Country | US
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Telephone | 949-648-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 2820 PARK PL
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2039
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Country | US
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Telephone | 908-279-3553
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY13932
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License Number State | CA
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