Provider Demographics
NPI:1245632645
Name:OLSON, ANDREW D SR (MSED,QMHP,LPC,NCC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:D
Last Name:OLSON
Suffix:SR
Gender:M
Credentials:MSED,QMHP,LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3807
Mailing Address - Country:US
Mailing Address - Phone:309-868-4514
Mailing Address - Fax:
Practice Address - Street 1:828 16TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3807
Practice Address - Country:US
Practice Address - Phone:309-868-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional