Provider Demographics
NPI:1972861367
Name:OLIVE TREE PLACE INC.
Entity Type:Organization
Organization Name:OLIVE TREE PLACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC CLINICAL NURSE SPECIALI
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PMH-CNS
Authorized Official - Phone:765-404-8317
Mailing Address - Street 1:1411 W 500 S
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8146
Mailing Address - Country:US
Mailing Address - Phone:765-404-8317
Mailing Address - Fax:
Practice Address - Street 1:2218 MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3614
Practice Address - Country:US
Practice Address - Phone:765-446-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28093092A364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty