Provider Demographics
NPI:1568916567
Name:OLSON, ANDREW (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 SAFFRON LN SE
Mailing Address - Street 2:APARTMENT 3B
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7354
Mailing Address - Country:US
Mailing Address - Phone:616-560-5133
Mailing Address - Fax:
Practice Address - Street 1:3181 PRAIRIE ST SW
Practice Address - Street 2:SUITE 100
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2097
Practice Address - Country:US
Practice Address - Phone:616-560-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional