Provider Demographics
NPI:1699415166
Name:OLHEISER, TAYLOR ALEXANDRIA (LAC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ALEXANDRIA
Last Name:OLHEISER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 31ST ST NW APT 110
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-1416
Mailing Address - Country:US
Mailing Address - Phone:701-321-3153
Mailing Address - Fax:
Practice Address - Street 1:3111 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-5085
Practice Address - Country:US
Practice Address - Phone:701-751-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1925101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)