Provider Demographics
NPI:1225268832
Name:OLIVE TREE COUNSELING, INC.
Entity Type:Organization
Organization Name:OLIVE TREE COUNSELING, INC.
Other - Org Name:OLIVE TREE COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:907-357-6513
Mailing Address - Street 1:1981 E PALMER WASILLA HWY STE 220
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7287
Mailing Address - Country:US
Mailing Address - Phone:907-357-6513
Mailing Address - Fax:907-354-6514
Practice Address - Street 1:1981 E PALMER WASILLA HWY STE 220
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7287
Practice Address - Country:US
Practice Address - Phone:907-357-6513
Practice Address - Fax:907-354-6514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK558101YA0400X, 101YP2500X
AK770101YA0400X, 101YM0800X
AK224101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty