Provider Demographics
NPI:1962933689
Name:OLSEN, MEGHAN (MA, LPCC, BCBA)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MA, LPCC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14301 EWING AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-4885
Mailing Address - Country:US
Mailing Address - Phone:952-746-5350
Mailing Address - Fax:952-746-6131
Practice Address - Street 1:14301 EWING AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4885
Practice Address - Country:US
Practice Address - Phone:952-746-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health