Provider Demographics
NPI:1891239505
Name:OLMSTEAD, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 GEORGETOWN RD NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3553
Mailing Address - Country:US
Mailing Address - Phone:423-457-1907
Mailing Address - Fax:844-580-4936
Practice Address - Street 1:2409 GEORGETOWN RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3553
Practice Address - Country:US
Practice Address - Phone:423-457-1907
Practice Address - Fax:844-580-4936
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-16-24891103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ030314Medicaid