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NPI Code Detail

MEDICARE: KEITH OLSON CADC INTERN

MEDICARE: KEITH OLSON CADC INTERN
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
1103K00000XBehavior Analyst
2101YM0800XMental Health Counselor
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1710262480
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH OLSON CADC INTERN
Provider Business Mailing Address
First Line : 205 S PRATT AVE
Second Line :
City : CARSON CITY
State : NV
Zip : 89701-4730
Country : US
Telephone Number : 775-882-3945
Fax Number : 775-882-6126
Provider Business Practice Location Address
First Line : 205 S PRATT AVE
Second Line :
City : CARSON CITY
State : NV
Zip : 89701-4730
Country : US
Telephone Number : 775-882-3945
Fax Number : 775-882-6126
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2011
Last Update Date : 06/12/2013

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Directions to “ KEITH OLSON CADC INTERN” Practice Location

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