Doctor Name: | MR. GREG PATRICK OLSON |
NPI Number: | 1003248584 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RRW |
License Number: | |
Business Practice Address: | 1100 W Shaw Ave Ste 122 Fresno, CA - 937113708 |
Business Phone Number: | 5596811947 |
Business Fax Number: | 5594122126 |
Mailing Address: | 1100 W Shaw Ave Ste 122, FRESNO |
State: | CA |
Postal Code: | 937113708 |
Phone Number: | 5596811947 |
Fax Number: | 5594122126 |
NPI Enumeration Date: | 08/06/2013 |
NPI Last Update Date: | 08/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |