Provider Demographics
NPI:1841845682
Name:MUSSMAN, OLESYA MIKHEEVA
Entity type:Individual
Prefix:
First Name:OLESYA
Middle Name:MIKHEEVA
Last Name:MUSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLESYA
Other - Middle Name:
Other - Last Name:MIKHEEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:435 LARCH ST
Mailing Address - Street 2:
Mailing Address - City:ONAWAY
Mailing Address - State:ID
Mailing Address - Zip Code:83855-8759
Mailing Address - Country:US
Mailing Address - Phone:509-730-5090
Mailing Address - Fax:509-553-8002
Practice Address - Street 1:435 LARCH ST
Practice Address - Street 2:
Practice Address - City:ONAWAY
Practice Address - State:ID
Practice Address - Zip Code:83855-8759
Practice Address - Country:US
Practice Address - Phone:509-730-5090
Practice Address - Fax:509-553-8002
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY203595103TC0700X
WAMC60974048101YM0800X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPY61045946OtherWA LICENSE