Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 34890 | TX |
NPI | 1033496799 |
---|---|
Provider Name | Glenn Richard Olds JR. |
First Address | Austin, TX 78703-4555 |
Second Address | Austin, TX 78703-4555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2011 |
Last Update Date | 09/11/2011 |