MEDICARE: OLIVE BRANCH COUNSELING 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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1588514210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE BRANCH COUNSELING LLC

Provider Business Mailing Address
First Line	:	900 VAN HOUTEN AVE APT B4
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-2721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 VAN HOUTEN AVE APT B4
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-2721
Country	:	US
Telephone Number	:	201-591-5232
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ROY RIM
Credential	:	LMFT
Telephone Number	:	201-660-2398

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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