=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811261647
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRAIG D. OLSON PSY.D. & ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2012
-----------------------------------------------------
Last Update Date | 09/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7071 CORPORATE WAY SUITE 106
-----------------------------------------------------
City | CENTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-436-5999
-----------------------------------------------------
Fax | 937-530-2304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 751371
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45475-1371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-436-5999
-----------------------------------------------------
Fax | 937-435-5929
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. CRAIG DOUGLAS OLSON
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 937-436-5999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 4487
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 4487
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------