Provider Demographics
NPI:1265289276
Name:OLSON, GREG LEE (RBT, CNA)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:LEE
Last Name:OLSON
Suffix:
Gender:M
Credentials:RBT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 S 950 W
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5726
Mailing Address - Country:US
Mailing Address - Phone:801-794-1522
Mailing Address - Fax:
Practice Address - Street 1:545 W 465 N STE 100
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-8004
Practice Address - Country:US
Practice Address - Phone:435-753-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-24-344684106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician