Provider Demographics
NPI:1750051868
Name:OLIVE TREE MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:OLIVE TREE MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WIJAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-341-8600
Mailing Address - Street 1:304 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLANCHARDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53516-9002
Mailing Address - Country:US
Mailing Address - Phone:608-341-8600
Mailing Address - Fax:608-341-8600
Practice Address - Street 1:304 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANCHARDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53516-9002
Practice Address - Country:US
Practice Address - Phone:608-341-8600
Practice Address - Fax:608-341-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty