Active NPI
David Glenn Olson, PSYD
- Clinical Psychologist
- Edina, MN
National Provider Identifier
1174745681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- MNLP3475
- Practice address
- 4005 W 65TH St
Suite 204
Edina, MN 55435-1720 - Phone
- (952) 920-2282
- Fax
- (952) 920-2219
- NPI assigned
- May 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | MNLP3475 | MN | Primary |
Addresses
Primary practice location
4005 W 65TH St
Suite 204
Edina, MN 55435-1720
Mailing address
4005 W 65TH St
Suite 204
Edina, MN 55435-1720
Phone (952) 920-2282
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6164976 | Other | MN | UBH MEDICA |
| 291M8NE | Other | MN | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MNLP3475 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Day Counseling Clinic | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Edina, MN
- NPI 1710005897
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174745681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 W 65TH ST",
"address_2": "SUITE 204",
"city": "EDINA",
"state": "MN",
"postal_code": "554351720",
"telephone_number": "952-920-2282",
"fax_number": "952-920-2219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 W 65TH ST",
"address_2": "SUITE 204",
"city": "EDINA",
"state": "MN",
"postal_code": "554351720",
"telephone_number": "952-920-2282",
"fax_number": "952-920-2219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "DAVID",
"middle_name": "GLENN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "MNLP3475",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH MEDICA",
"identifier": "6164976",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "291M8NE",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.