Provider Demographics
NPI:1972204964
Name:OLMSTEAD, JUSTIN (MSMFT, LAC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:OLMSTEAD
Suffix:
Gender:M
Credentials:MSMFT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 E SILVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2041
Mailing Address - Country:US
Mailing Address - Phone:480-341-1885
Mailing Address - Fax:602-753-9527
Practice Address - Street 1:3303 E BASELINE RD STE 109
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2739
Practice Address - Country:US
Practice Address - Phone:480-341-1885
Practice Address - Fax:602-753-9527
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21099101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor