Provider Demographics
NPI:1609873884
Name:OLSEN, DAMARIS A (PHD, RN, MSN)
Entity Type:Individual
Prefix:DR
First Name:DAMARIS
Middle Name:A
Last Name:OLSEN
Suffix:
Gender:F
Credentials:PHD, RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 LONAS DR., BLDG II
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3247
Mailing Address - Country:US
Mailing Address - Phone:865-588-7132
Mailing Address - Fax:865-558-5967
Practice Address - Street 1:5516 LONAS DR., BLDG II
Practice Address - Street 2:SUITE 250
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3247
Practice Address - Country:US
Practice Address - Phone:865-588-7132
Practice Address - Fax:865-558-5967
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNP0000001198103TC0700X
TNTNRN0000028104163WP0809X
MNMDGL0004103TC0700X
TNP0000001198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3687897Medicaid
TNP0000001198OtherPSYCHOLOGIST, BOARD OF EX
TN3687897Medicaid