Provider Demographics
NPI:1083640619
Name:OLSHAN, NEAL HUGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:HUGH
Last Name:OLSHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 E CHOLLA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-2304
Mailing Address - Country:US
Mailing Address - Phone:602-705-1144
Mailing Address - Fax:602-840-2139
Practice Address - Street 1:4720 E CHOLLA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-2304
Practice Address - Country:US
Practice Address - Phone:602-705-1144
Practice Address - Fax:602-840-2139
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ429103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0132670OtherBLUE CROSS BLUE SHIELD
AZ1083640619Medicare PIN
AZ1144493248Medicare PIN