Provider Demographics
NPI:1841398146
Name:OLSON, GREGG (LMFT, RN)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:LMFT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5824
Mailing Address - Country:US
Mailing Address - Phone:541-207-7136
Mailing Address - Fax:
Practice Address - Street 1:2411 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5824
Practice Address - Country:US
Practice Address - Phone:541-207-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34228106H00000X
OR200840395RN163W00000X
ORTO556106H00000X
CA288983163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist