Provider Demographics
NPI:1790472124
Name:OLIVE BRANCH INTEGRATIVE MENTAL WELLNESS, LLC
Entity Type:Organization
Organization Name:OLIVE BRANCH INTEGRATIVE MENTAL WELLNESS, LLC
Other - Org Name:OLIVE BRANCH INTEGRATIVE MENTAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-PMHNP-BC
Authorized Official - Phone:302-242-5463
Mailing Address - Street 1:31 GOODEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4143
Mailing Address - Country:US
Mailing Address - Phone:302-249-2648
Mailing Address - Fax:
Practice Address - Street 1:31 GOODEN AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4143
Practice Address - Country:US
Practice Address - Phone:302-249-2648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty