Provider Demographics
NPI:1306919287
Name:OLSON, MICHAEL L (PH D)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:OLSON
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 196TH ST SW STE 208
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6152
Mailing Address - Country:US
Mailing Address - Phone:206-387-7100
Mailing Address - Fax:425-670-6578
Practice Address - Street 1:5108 196TH ST SW STE 208
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6152
Practice Address - Country:US
Practice Address - Phone:206-387-7100
Practice Address - Fax:425-670-6578
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1263103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical