MEDICARE: OLAS PSYCHOLOGY 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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1346074465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLAS PSYCHOLOGY PLLC

Provider Business Mailing Address
First Line	:	1828 JEFFERSON ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-4427
Country	:	US
Telephone Number	:	787-381-1055
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 JEFFERSON ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-4427
Country	:	US
Telephone Number	:	787-381-1055
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. MARIE A DIAZ
Credential	:	LP
Telephone Number	:	787-381-1055

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	08/30/2024

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