Provider Demographics
NPI:1972724110
Name:OLSEN, LAWRENCE STEWART (PHD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:STEWART
Last Name:OLSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 E 2700 S STE 180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1759
Mailing Address - Country:US
Mailing Address - Phone:801-230-6508
Mailing Address - Fax:801-322-3890
Practice Address - Street 1:2005 E 2700 S STE 180
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1759
Practice Address - Country:US
Practice Address - Phone:801-230-6508
Practice Address - Fax:801-322-3890
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT102121-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist