Provider Demographics
NPI:1780910786
Name:OLSON, TIMOTHY M (MFT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:M
Last Name:OLSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1451 RIMPAU AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7520
Mailing Address - Country:US
Mailing Address - Phone:808-391-3595
Mailing Address - Fax:951-463-4043
Practice Address - Street 1:31681 RIVERSIDE DR
Practice Address - Street 2:SUITE L
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-7815
Practice Address - Country:US
Practice Address - Phone:808-391-3595
Practice Address - Fax:951-463-4043
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA52764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist