Provider Demographics
NPI:1538657572
Name:OLIVE BRANCH BEHAVIORAL HEALTH COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:OLIVE BRANCH BEHAVIORAL HEALTH COUNSELING SERVICES, INC
Other - Org Name:OLIVE BRANCH BEHAVIORAL HEALTH COUNSELING SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROFESSIOAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LACYNDA
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MHR
Authorized Official - Phone:405-585-3833
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-0589
Mailing Address - Country:US
Mailing Address - Phone:405-585-3833
Mailing Address - Fax:405-598-6770
Practice Address - Street 1:602 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-2020
Practice Address - Country:US
Practice Address - Phone:405-585-3833
Practice Address - Fax:405-598-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6747101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty