Provider Demographics
NPI:1689930083
Name:OLSEN, LORI NICOLE (MS)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:NICOLE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 VILLAGER CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7359
Mailing Address - Country:US
Mailing Address - Phone:850-221-5109
Mailing Address - Fax:
Practice Address - Street 1:2828 VILLAGER CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7359
Practice Address - Country:US
Practice Address - Phone:850-221-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor