Provider Demographics
NPI:1457686362
Name:OLSEN, AMY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1806
Mailing Address - Country:US
Mailing Address - Phone:208-957-7900
Mailing Address - Fax:208-939-9009
Practice Address - Street 1:849 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1806
Practice Address - Country:US
Practice Address - Phone:208-957-7900
Practice Address - Fax:208-939-9009
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional