Provider Demographics
NPI:1083893911
Name:OLSEN, LORI J (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 E MINTON ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-1697
Mailing Address - Country:US
Mailing Address - Phone:480-232-4302
Mailing Address - Fax:
Practice Address - Street 1:2158 N GILBERT RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2109
Practice Address - Country:US
Practice Address - Phone:480-232-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC12825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional