Provider Demographics
NPI:1144994146
Name:OLSSON, MIKKI MARIE (LPC)
Entity type:Individual
Prefix:
First Name:MIKKI
Middle Name:MARIE
Last Name:OLSSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1636
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-1636
Mailing Address - Country:US
Mailing Address - Phone:318-270-3265
Mailing Address - Fax:318-270-3113
Practice Address - Street 1:130 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2602
Practice Address - Country:US
Practice Address - Phone:318-872-2700
Practice Address - Fax:318-872-6214
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
LA5133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional