Provider Demographics
NPI:1396868766
Name:OLWELL, AMY MELISSAO (LCSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:MELISSAO
Last Name:OLWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 HERITAGE ST
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-2716
Mailing Address - Country:US
Mailing Address - Phone:406-207-3381
Mailing Address - Fax:
Practice Address - Street 1:115 W 3RD ST
Practice Address - Street 2:SUITE 212
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2038
Practice Address - Country:US
Practice Address - Phone:406-777-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0501942Medicaid