Provider Demographics
NPI:1477621100
Name:OLSEN, DEBORAH L (MS LPC-MH QMHP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MS LPC-MH QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S MAIN ST
Mailing Address - Street 2:SUITE 516
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4155
Mailing Address - Country:US
Mailing Address - Phone:605-725-2701
Mailing Address - Fax:605-725-2702
Practice Address - Street 1:202 S MAIN ST
Practice Address - Street 2:SUITE 516
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4155
Practice Address - Country:US
Practice Address - Phone:605-725-2701
Practice Address - Fax:605-725-2702
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2092101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575810Medicaid
SD4994579OtherBCBS PROVIDER ID