Provider Demographics
NPI:1700028057
Name:OLSON, MARK LOREN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LOREN
Last Name:OLSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BAKER ROAD
Mailing Address - Street 2:WATERTOWER PLACE
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343
Mailing Address - Country:US
Mailing Address - Phone:952-936-9982
Mailing Address - Fax:
Practice Address - Street 1:4300 BAKER RD
Practice Address - Street 2:WATERTOWER PLACE
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-8600
Practice Address - Country:US
Practice Address - Phone:952-936-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist