Provider Demographics
NPI:1083691588
Name:OLSON, SETH DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:DAVID
Last Name:OLSON
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 1:6809 S. MINNESOTA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108
Mailing Address - Country:US
Mailing Address - Phone:605-809-8328
Mailing Address - Fax:605-271-2548
Practice Address - Street 1:6809 S. MINNESOTA AVE STE 103
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-809-8328
Practice Address - Fax:605-271-2548
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCC101YM0800X
SDLPC7037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
57506OtherNBCC