Provider Demographics
NPI:1891798922
Name:OLSON-BURKHARDT, DIANE K (LMHC, NCC, RPT-S06)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:OLSON-BURKHARDT
Suffix:
Gender:F
Credentials:LMHC, NCC, RPT-S06
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 WALL ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:260-519-1234
Mailing Address - Fax:574-269-3995
Practice Address - Street 1:502 WALL ST
Practice Address - Street 2:SUITE 105
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:260-519-1234
Practice Address - Fax:574-269-3995
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001475A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health