Provider Demographics
NPI:1083067888
Name:OLSEN, THOMAS L (MA MFTI, LPCC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MA MFTI, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 LAUREL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5019
Mailing Address - Country:US
Mailing Address - Phone:650-219-2135
Mailing Address - Fax:
Practice Address - Street 1:2600 S EL CAMINO REAL
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2380
Practice Address - Country:US
Practice Address - Phone:650-373-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93920106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist