Provider Demographics
NPI:1912536210
Name:OLSEN, KRISTEL (MED, MS, LPC INTERN)
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MED, MS, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 HIGHWAY 99 N # 203E
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-8900
Mailing Address - Country:US
Mailing Address - Phone:971-412-5497
Mailing Address - Fax:
Practice Address - Street 1:1661 HIGHWAY 99 N # 203E
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-8900
Practice Address - Country:US
Practice Address - Phone:971-412-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health