Provider Demographics
NPI:1699196337
Name:MARIE CASEY OLSETH, MD, LLC
Entity Type:Organization
Organization Name:MARIE CASEY OLSETH, MD, LLC
Other - Org Name:WEST END CONSULTATION GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:OLSETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-804-3548
Mailing Address - Street 1:23790 LAWTONKA DR
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-1767
Mailing Address - Country:US
Mailing Address - Phone:612-804-3548
Mailing Address - Fax:952-746-4383
Practice Address - Street 1:1550 UTICA AVE S
Practice Address - Street 2:STE 450
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5312
Practice Address - Country:US
Practice Address - Phone:952-856-8452
Practice Address - Fax:952-746-4383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-24
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNPY 49497261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health