Provider Demographics
NPI:1982208773
Name:OLIVE COUNSELING LLC
Entity Type:Organization
Organization Name:OLIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCPC
Authorized Official - Phone:312-883-4077
Mailing Address - Street 1:10223 CHERRY LN APT 203
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-4344
Mailing Address - Country:US
Mailing Address - Phone:312-883-4077
Mailing Address - Fax:
Practice Address - Street 1:824 17TH AVE S STE 7
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4781
Practice Address - Country:US
Practice Address - Phone:312-883-4077
Practice Address - Fax:208-697-5208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty