Provider Demographics
NPI:1013321413
Name:OLSON, REBECCA (LMHC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:809 CENTRAL AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3916
Mailing Address - Country:US
Mailing Address - Phone:515-599-1945
Mailing Address - Fax:
Practice Address - Street 1:809 CENTRAL AVE STE 430
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-3916
Practice Address - Country:US
Practice Address - Phone:515-599-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health