Provider Demographics
NPI:1144619529
Name:OLIVE BRANCH WELLNESS, PLLC
Entity Type:Organization
Organization Name:OLIVE BRANCH WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-814-6872
Mailing Address - Street 1:3705 MEDICAL PKWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1019
Mailing Address - Country:US
Mailing Address - Phone:512-814-6872
Mailing Address - Fax:888-909-8093
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-814-6872
Practice Address - Fax:888-909-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP25942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty