Provider Demographics
NPI:1184768913
Name:OLSEN, MICHAEL DONOVAN (MA MFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DONOVAN
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MA MFT
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 2046
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-2046
Mailing Address - Country:US
Mailing Address - Phone:626-335-3235
Mailing Address - Fax:
Practice Address - Street 1:535 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3013
Practice Address - Country:US
Practice Address - Phone:626-974-0770
Practice Address - Fax:626-974-0774
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46226106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist