Provider Demographics
NPI:1831677103
Name:OLSON, MITCHELL LEE (LPCC)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:LEE
Last Name:OLSON
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 LAKEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-2500
Mailing Address - Country:US
Mailing Address - Phone:763-245-0990
Mailing Address - Fax:
Practice Address - Street 1:4154 SHORELINE DR STE 202
Practice Address - Street 2:
Practice Address - City:SPRING PARK
Practice Address - State:MN
Practice Address - Zip Code:55384-5606
Practice Address - Country:US
Practice Address - Phone:612-562-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health