Provider Demographics
NPI:1518390863
Name:OLSON, RICHARD (LMFT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:41765 12TH ST W STE D
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1422
Mailing Address - Country:US
Mailing Address - Phone:661-940-4861
Mailing Address - Fax:661-942-4511
Practice Address - Street 1:41765 12TH ST W STE D
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1422
Practice Address - Country:US
Practice Address - Phone:661-940-4861
Practice Address - Fax:661-942-4511
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 27410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457422552OtherNPI