Provider Demographics
NPI:1194569509
Name:OLSEN, TEA (LPC-IT)
Entity type:Individual
Prefix:
First Name:TEA
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:TEA
Other - Middle Name:
Other - Last Name:MIRKOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2971 W YORKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-7004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9735 W SAINT MARTINS RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9830
Practice Address - Country:US
Practice Address - Phone:414-540-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7959-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health