Provider Demographics
NPI:1396525028
Name:OLSON, ELIZABETH (PSYD, LCSW)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 NOEL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8926
Mailing Address - Country:US
Mailing Address - Phone:303-596-1735
Mailing Address - Fax:
Practice Address - Street 1:2500 30TH ST STE 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1238
Practice Address - Country:US
Practice Address - Phone:303-596-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSYD4241103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis