Provider Demographics
NPI:1851451447
Name:OLSON, MICHAEL M (PHD LMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:OLSON
Suffix:
Gender:M
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1385
Mailing Address - Country:US
Mailing Address - Phone:409-772-2166
Mailing Address - Fax:409-772-2663
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1385
Practice Address - Country:US
Practice Address - Phone:409-772-2166
Practice Address - Fax:409-772-2663
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201757106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN