Provider Demographics
NPI:1679021133
Name:OLSON, THERESA (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 N ROCK ISLAND RD APT 207
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8184
Mailing Address - Country:US
Mailing Address - Phone:561-899-9332
Mailing Address - Fax:954-666-0440
Practice Address - Street 1:11555 HERON BAY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3362
Practice Address - Country:US
Practice Address - Phone:561-899-9332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No171W00000XOther Service ProvidersContractor