Provider Demographics
NPI:1942663968
Name:OLSON, NATHAN (CSWA, QMHP, CADC III)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:CSWA, QMHP, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CHERRY WOOD
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-6629
Mailing Address - Country:US
Mailing Address - Phone:541-951-8168
Mailing Address - Fax:
Practice Address - Street 1:315 CHERRY WOOD
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-6629
Practice Address - Country:US
Practice Address - Phone:541-951-8168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORQMHP101YM0800X
101YA0400X
OR19-QMHPC-00526101YM0800X
ORA13390104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500754425Medicaid
OR500754425Medicaid