Provider Demographics
NPI:1457665408
Name:OLSON, KORAL J (MS, LPC, NCC, CBIS)
Entity Type:Individual
Prefix:MRS
First Name:KORAL
Middle Name:J
Last Name:OLSON
Suffix:
Gender:F
Credentials:MS, LPC, NCC, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4211
Mailing Address - Country:US
Mailing Address - Phone:605-641-2112
Mailing Address - Fax:
Practice Address - Street 1:625 1/2 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2758
Practice Address - Country:US
Practice Address - Phone:605-863-2498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional