Doctor Name: | MRS. AMY OLSEN |
NPI Number: | 1457686362 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | LPC 3062 |
Business Practice Address: | 190 W. Main Street Downstairs Kuna, ID - 83634 |
Business Phone Number: | 2089229001 |
Business Fax Number: | 2089223778 |
Mailing Address: | Po Box 959, KUNA |
State: | ID |
Postal Code: | 836340900 |
Phone Number: | 2089229001 |
Fax Number: | 2089223778 |
NPI Enumeration Date: | 10/09/2009 |
NPI Last Update Date: | 10/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC 3062 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |