Provider Demographics
NPI:1942446612
Name:OLSON, TASHAWNA LILLIAN (LPC)
Entity Type:Individual
Prefix:
First Name:TASHAWNA
Middle Name:LILLIAN
Last Name:OLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2914
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-2914
Mailing Address - Country:US
Mailing Address - Phone:907-235-8886
Mailing Address - Fax:
Practice Address - Street 1:42173 ROSEWOOD COURT
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-2914
Practice Address - Country:US
Practice Address - Phone:907-235-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA 25101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK825709000OtherMAGELLAN