Provider Demographics
NPI:1619478088
Name:OLSEN, JUDITH ELAINE (MS ED; ED S; LPC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELAINE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MS ED; ED S; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6253 THORNAPPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-8285
Mailing Address - Country:US
Mailing Address - Phone:269-908-1595
Mailing Address - Fax:
Practice Address - Street 1:607 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1471
Practice Address - Country:US
Practice Address - Phone:269-908-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional