Provider Demographics
NPI:1639376627
Name:MICHAEL L. OLSON PHD INC PS
Entity Type:Organization
Organization Name:MICHAEL L. OLSON PHD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-387-7100
Mailing Address - Street 1:5108 196TH ST SW STE 208
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6152
Mailing Address - Country:US
Mailing Address - Phone:206-387-7100
Mailing Address - Fax:425-670-6578
Practice Address - Street 1:5108 196TH ST SW STE 208
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6152
Practice Address - Country:US
Practice Address - Phone:206-387-7100
Practice Address - Fax:425-670-6578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1263103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7139405Medicaid