Provider Demographics
NPI:1013475995
Name:OLSON, MATTHEW E (LMFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:OLSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 EXCELSIOR BLVD STE 335
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5228
Mailing Address - Country:US
Mailing Address - Phone:612-568-7819
Mailing Address - Fax:
Practice Address - Street 1:4601 EXCELSIOR BLVD STE 335
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5228
Practice Address - Country:US
Practice Address - Phone:612-568-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-09
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist