Provider Demographics
NPI:1508649633
Name:OLIVE BRANCH WELLNESS, PLLC
Entity Type:Organization
Organization Name:OLIVE BRANCH WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SABA
Authorized Official - Middle Name:
Authorized Official - Last Name:AQEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-625-3537
Mailing Address - Street 1:332 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 121 # 5932
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604
Mailing Address - Country:US
Mailing Address - Phone:312-625-3537
Mailing Address - Fax:
Practice Address - Street 1:332 S MICHIGAN AVE SUITE 121 # 5932
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604
Practice Address - Country:US
Practice Address - Phone:312-625-3537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty