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General NPI Number Information
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NPI Number | 1659565026
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Entity Type | Organization
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Legal Business Name | PHYLLIS M OLSON PSYD HSPP LLC
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 3310 S MAIN ST SUITE D1
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City | ANDERSON
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State | IN
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Zip | 46013-4234
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Country | US
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Telephone | 765-622-7622
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Fax | 765-622-9032
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Provider Business Mailing Address
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Address Line | 3310 S MAIN ST SUITE D1
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City | ANDERSON
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State | IN
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Zip | 46013-4234
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Country | US
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Telephone | 765-622-7622
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. PHYLLIS M OLSON
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Credential | PSY.D., HSPP
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Telephone | 765-622-7622
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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 | 20041304A
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License Number State | IN
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