Provider Demographics
NPI:1164441846
Name:OLSON, PETER ERIC (LP)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ERIC
Last Name:OLSON
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8085 WAYZATA BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1453
Mailing Address - Country:US
Mailing Address - Phone:952-546-7056
Mailing Address - Fax:952-847-5247
Practice Address - Street 1:8085 WAYZATA BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1453
Practice Address - Country:US
Practice Address - Phone:952-546-7056
Practice Address - Fax:952-847-5247
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0604103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41-1691779OtherFED TAX ID #