Provider Demographics
NPI:1265592265
Name:OLSON, PEGGY L
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S PETERS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5207
Mailing Address - Country:US
Mailing Address - Phone:865-406-2860
Mailing Address - Fax:865-309-5651
Practice Address - Street 1:224 S PETERS RD STE 204
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-406-2860
Practice Address - Fax:865-309-5651
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ037824Medicaid