Provider Demographics
NPI:1558620096
Name:OLSEN, MICHAEL S (LFMT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:OLSEN
Suffix:
Gender:M
Credentials:LFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 COMMERCIAL ST
Mailing Address - Street 2:STE 307
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4553
Mailing Address - Country:US
Mailing Address - Phone:503-479-5531
Mailing Address - Fax:
Practice Address - Street 1:818 COMMERCIAL ST
Practice Address - Street 2:STE 307
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4553
Practice Address - Country:US
Practice Address - Phone:503-479-5531
Practice Address - Fax:888-977-3040
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist