Provider Demographics
NPI:1265481055
Name:OLSEN, MILTON C (LPC, PHD)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:C
Last Name:OLSEN
Suffix:
Gender:M
Credentials:LPC, PHD
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 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-660-3632
Mailing Address - Fax:918-660-3631
Practice Address - Street 1:4502 E 41ST ST
Practice Address - Street 2:STE 1C18
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2553
Practice Address - Country:US
Practice Address - Phone:918-660-3130
Practice Address - Fax:918-660-3132
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK90101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional