Provider Demographics
NPI:1821820242
Name:OLSON, HAYLEY DANIELLE
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:DANIELLE
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:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:GRUVER
Mailing Address - State:TX
Mailing Address - Zip Code:79040-0503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:614 WOMBLE AVE
Practice Address - Street 2:
Practice Address - City:GRUVER
Practice Address - State:TX
Practice Address - Zip Code:79040-1119
Practice Address - Country:US
Practice Address - Phone:806-543-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional