MEDICARE: LARISSA OLSON, LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1205390861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARISSA OLSON, LCSW PLLC

Provider Business Mailing Address
First Line	:	2423 MULLAN RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1827
Country	:	US
Telephone Number	:	406-499-2472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2423 MULLAN RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1827
Country	:	US
Telephone Number	:	406-499-2472
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LARISSA OLSON
Credential	:	LCSW
Telephone Number	:	406-274-4652

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	03/05/2023

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