Provider Demographics
NPI:1942961172
Name:OLIVE BRANCH COUNSELING LLC
Entity Type:Organization
Organization Name:OLIVE BRANCH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-924-3627
Mailing Address - Street 1:2581 WASHINGTON RD STE 221
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2564
Mailing Address - Country:US
Mailing Address - Phone:724-250-8183
Mailing Address - Fax:
Practice Address - Street 1:2581 WASHINGTON RD STE 221
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-2564
Practice Address - Country:US
Practice Address - Phone:724-250-8183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1942879937OtherINDIVIDUAL NPI