Provider Demographics
NPI:1073782967
Name:OLSEN, TRACEY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2102
Mailing Address - Country:US
Mailing Address - Phone:602-452-4697
Mailing Address - Fax:
Practice Address - Street 1:2017 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2102
Practice Address - Country:US
Practice Address - Phone:602-452-4697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health