Olesya Mikheeva Mussman
Individual provider Active NPI Clinical Psychologist · Onaway, ID
NPI 1841845682 · NPPES record last updated May 10, 2024
Key facts
- NPI
- 1841845682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY203595 (ID)
- Practice address
- 435 Larch St
Onaway, ID 83855-8759 - Phone
- (509) 730-5090
- Fax
- (509) 553-8002
- NPI assigned
- Aug 8, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211004000242 | WA | Practitioner - Clinical Psychologist | 8224436498 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC60974048 | WA | MD | Mental Health Counselor |
| PSY203595 | ID | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Palouse River Counseling Center | Current |
Accepting new patients |
Locations
340 NE Maple St
Pullman, WA 99163
Phone (509) 334-1133
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY203595 | ID | Yes |
| Mental Health Counselor | 101YM0800X | MC60974048 | WA | |
| Counseling Psychologist | 103TC1900X |
Addresses
Primary practice location
435 Larch St
Onaway, ID 83855-8759
Mailing address
435 Larch St
Onaway, ID 83855-8759
Phone (509) 730-5090
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PY61045946 | Other | WA | WA LICENSE |
Other names
- Olesya Mikheeva
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.