Provider Demographics
NPI:1578348371
Name:OLSON, EMILY NICOLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:NICOLE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:NICOLE
Other - Last Name:LANDOLFI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:17363 W BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2571
Mailing Address - Country:US
Mailing Address - Phone:480-536-5112
Mailing Address - Fax:
Practice Address - Street 1:4150 W PEORIA AVE STE 128
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3952
Practice Address - Country:US
Practice Address - Phone:480-536-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional