Provider Demographics
NPI:1770028813
Name:OLIVE TREE THERAPY LLC
Entity Type:Organization
Organization Name:OLIVE TREE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARSELLA-GONIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-335-3027
Mailing Address - Street 1:3451 24TH AVE W
Mailing Address - Street 2:L522
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2200
Mailing Address - Country:US
Mailing Address - Phone:253-335-3027
Mailing Address - Fax:
Practice Address - Street 1:3515 SW ALASKA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2730
Practice Address - Country:US
Practice Address - Phone:425-243-3476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60604590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty