Provider Demographics
NPI:1336582873
Name:OLIN, COLLEEN CAROL (CPC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:CAROL
Last Name:OLIN
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:CAROL
Other - Last Name:TEDLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7640 40TH ST W
Mailing Address - Street 2:APT 44
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-3811
Mailing Address - Country:US
Mailing Address - Phone:253-298-7818
Mailing Address - Fax:
Practice Address - Street 1:1305 TACOMA AVE S
Practice Address - Street 2:SUITE 305
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1903
Practice Address - Country:US
Practice Address - Phone:253-396-5800
Practice Address - Fax:253-825-5548
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60333393101Y00000X
WALH60817961101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor