Provider Demographics
NPI:1790563930
Name:OLIVE BRANCH COUNSELING INC
Entity Type:Organization
Organization Name:OLIVE BRANCH COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAPWYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-366-0855
Mailing Address - Street 1:1321 EASTSIDE HWY
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-9696
Mailing Address - Country:US
Mailing Address - Phone:406-366-0855
Mailing Address - Fax:
Practice Address - Street 1:1967 N 1ST ST APT B
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3198
Practice Address - Country:US
Practice Address - Phone:406-361-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty