Provider Demographics
NPI:1275519688
Name:OLSEN, HOWARD (LPC, LMSW, LM)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:
Last Name:OLSEN
Suffix:
Gender:M
Credentials:LPC, LMSW, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48675
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76148-0675
Mailing Address - Country:US
Mailing Address - Phone:817-846-9718
Mailing Address - Fax:
Practice Address - Street 1:4700 N BEACH ST
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76137-3221
Practice Address - Country:US
Practice Address - Phone:817-846-9718
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11962101YP2500X
TX215981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical