MEDICARE: OLIVE BRANCH FAMILY THERAPY INC.

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	101YP1600X	Pastoral Counselor
2	106H00000X	Marriage & Family Therapist	201076	TX
3	106H00000X	Marriage & Family Therapist	201168	TX

General Provider Information

NPI Number	:	1669755443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE BRANCH FAMILY THERAPY INC.

Provider Business Mailing Address
First Line	:	2406 ALLOWAY DR
Second Line	:
City	:	CORINTH
State	:	TX
Zip	:	76210-1506
Country	:	US
Telephone Number	:	940-483-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 DALLAS DR STE 6
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-5100
Country	:	US
Telephone Number	:	940-438-1789
Fax Number	:

Authorized Official
Title or Position	:	OWNER CEO
Name	:	BEAU D DAVIS
Credential	:	L.M.F.T.
Telephone Number	:	940-438-1789

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	03/18/2026

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