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NPI Code Detail

MEDICARE: THE OLIVE-TREE COMPANY, LLC

MEDICARE: THE OLIVE-TREE COMPANY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YP2500XProfessional Counselor
3103T00000XPsychologist
42084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1134271059
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE OLIVE-TREE COMPANY, LLC
Provider Business Mailing Address
First Line : 1979 N MILL ST
Second Line : SUITE 202
City : NAPERVILLE
State : IL
Zip : 60563-1200
Country : US
Telephone Number : 630-428-2344
Fax Number :
Provider Business Practice Location Address
First Line : 1979 N MILL ST
Second Line : SUITE 202
City : NAPERVILLE
State : IL
Zip : 60563-1200
Country : US
Telephone Number : 630-428-2344
Fax Number :
Authorized Official
Title or Position : OWNER CEO
Name : DR. NEFERTITI NOWELL
Credential : PHD
Telephone Number : 630-428-2344
Provider Enumeration Date : 01/18/2007
Last Update Date : 06/23/2008

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Directions to “THE OLIVE-TREE COMPANY, LLC ” Practice Location

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