Active NPI
Phyllis M. Olson
- Clinical Psychologist
- Anderson, IN
National Provider Identifier
1962427187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20041304A
- Practice address
- 3310 S Main Street
Suite D1
Anderson, IN 46013-4234 - Phone
- (765) 622-7622
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 20041304A | IN | Primary |
Addresses
Primary practice location
3310 S Main Street
Suite D1
Anderson, IN 46013-4234
Mailing address
PO Box 605
Alexandria, IN 46001-0605
Phone (765) 233-1102
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200203950 | Medicaid | IN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20041304A | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188950400000",
"number": "1962427187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 605",
"city": "ALEXANDRIA",
"state": "IN",
"postal_code": "460010605",
"telephone_number": "765-233-1102",
"fax_number": "765-233-1103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3310 S MAIN STREET",
"address_2": "SUITE D1",
"city": "ANDERSON",
"state": "IN",
"postal_code": "460134234",
"telephone_number": "765-622-7622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "PHYLLIS",
"middle_name": "M.",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-12",
"last_updated": "2007-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20041304A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200203950",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anderson, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.