Provider Demographics
NPI:1952401101
Name:OLSON, MARJORIE ELYN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:ELYN
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 PARKHURST DR
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-3392
Mailing Address - Country:US
Mailing Address - Phone:248-698-3408
Mailing Address - Fax:248-698-3405
Practice Address - Street 1:609 PARKHURST DR
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-3392
Practice Address - Country:US
Practice Address - Phone:248-698-3408
Practice Address - Fax:248-698-3405
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010805661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008974710OtherBCBS PIN
MIPO0279486OtherMEDICARE RR CARRIER PIN
MIOP17260Medicare ID - Type UnspecifiedPART B IN-HOME COUNSELING