Doctor Name: | MR. PAUL THEODORE OLSON |
NPI Number: | 1336480854 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMSW |
License Number: | |
Business Practice Address: | 97 S. 4th St Suite F Ishpeming, MI - 19849 |
Business Phone Number: | 9064852347 |
Business Fax Number: | 9064861150 |
Mailing Address: | 201 Rubleins St Suite A, Great Lakes Recovery Centers MARQUETTE |
State: | MI |
Postal Code: | 498554060 |
Phone Number: | 9062289699 |
Fax Number: | 9062280505 |
NPI Enumeration Date: | 03/07/2013 |
NPI Last Update Date: | 12/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |