Provider Demographics
NPI:1932522356
Name:OLIVE BRANCH COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:OLIVE BRANCH COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL CLINICAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LARA
Authorized Official - Last Name:DOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-805-4587
Mailing Address - Street 1:PO BOX 4034
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-0034
Mailing Address - Country:US
Mailing Address - Phone:330-805-4587
Mailing Address - Fax:330-805-4587
Practice Address - Street 1:444 N MAIN ST
Practice Address - Street 2:SUITE 408
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3110
Practice Address - Country:US
Practice Address - Phone:330-805-4587
Practice Address - Fax:330-805-4587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0007143251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health