Provider Demographics
NPI:1780774943
Name:OLSON, CRAIG DOUGLAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DOUGLAS
Last Name:OLSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 HARLAN RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-8768
Mailing Address - Country:US
Mailing Address - Phone:937-890-9804
Mailing Address - Fax:513-897-3821
Practice Address - Street 1:7071 CORPORATE WAY
Practice Address - Street 2:7071 CORPORATE WAY SUITE106
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-8911
Practice Address - Country:US
Practice Address - Phone:937-890-9804
Practice Address - Fax:513-897-3821
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000211199OtherANTHEM BC/BS
OHCP14401Medicare ID - Type Unspecified