Provider Information for 1295935286
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MARK S OLEXA MA, LPC, LMSW
Sex: Male
NPI: 1295935286
Last Updated: 2012-06-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1295935286 | ||||||||||||
| Enumeration Date | 2007-07-19 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3130 BROCKWOOD DR NE GRAND RAPIDS, MI 49525-1336 United States Phone: 616-560-4036 | Fax: | ||||||||||||
| Primary Practice Address | 4829 E BELTLINE AVE NE BUILDING ONE, SUITE 103 GRAND RAPIDS, MI 49525-9747 United States Phone: 616-560-4036 | Fax: | ||||||||||||
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