Provider Demographics
NPI:1164159497
Name:OLSON, LAURA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:EGLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-8320
Mailing Address - Country:US
Mailing Address - Phone:559-981-2795
Mailing Address - Fax:
Practice Address - Street 1:2200 E 19TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-8320
Practice Address - Country:US
Practice Address - Phone:650-549-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130405106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist