Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1073949368 |
---|---|
Provider Name | Thomas G Olson |
First Address | Portland, OR 97202-3371 |
Second Address | Portland, OR 97202-3371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2013 |
Last Update Date | 19/09/2013 |