Provider Demographics
NPI:1790067452
Name:OLSEN, EMILY BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:BETH
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:BETH
Other - Last Name:OSWALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 PARK CENTRAL SQ
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-1339
Mailing Address - Country:US
Mailing Address - Phone:844-536-8266
Mailing Address - Fax:
Practice Address - Street 1:134 PARK CENTRAL SQ
Practice Address - Street 2:SUITE 220
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1339
Practice Address - Country:US
Practice Address - Phone:844-536-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011014775104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker