NEIL I OLSON LAC

Addiction Substance Use Disorder

Grand Forks, North Dakota

Provider NPI: 1336171255

Provider Information:
 NEIL I OLSON LAC
Gender: M
Not Sole Proprietor

Practice Location:
151 S 4TH ST SUITE 401 GRAND FORKS, ND 58201 US
Tel: 701-795-3000  Fax: 701-795-3050

Business Mailing Address:
151 S 4TH ST SUITE 401 GRAND FORKS, ND 58201 US
Tel: 701-795-3000  Fax: 701-795-3050

Entity Type: Individual

Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	101YA0400X	Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder)	ND	1429

Other Provider Identifiers:

Issuer	Number	State	Type
BCBS ND PROVIDER NUMBER	015447	ND	01
	054519	ND	05
BCBS MN PROVIDER NUMBER	48B83OL	MN	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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