Provider Demographics
NPI:1598922502
Name:OLSON, PAUL A (PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:OLSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2960
Mailing Address - Country:US
Mailing Address - Phone:406-250-2077
Mailing Address - Fax:
Practice Address - Street 1:1125 7TH ST
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2846
Practice Address - Country:US
Practice Address - Phone:406-250-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional