Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY10995 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY10995 | CA |
NPI | 1013033174 |
---|---|
Provider Name | Dr. Eric Thomas Olsen |
First Address | Los Gatos, CA 95032-1420 |
Second Address | Los Gatos, CA 95032-1420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |