Provider Demographics
NPI:1598833774
Name:OLSON, JAMES F (LCMHC, BCBA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:F
Last Name:OLSON
Suffix:
Gender:F
Credentials:LCMHC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 AUSTINE DR
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7040
Mailing Address - Country:US
Mailing Address - Phone:802-579-5192
Mailing Address - Fax:
Practice Address - Street 1:212 FOX FARM RD
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-9135
Practice Address - Country:US
Practice Address - Phone:802-579-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000656101YP2500X
VT00000000000000103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011330Medicaid