Healthcare Provider Details

I. General information

NPI: 1225268832
Provider Name (Legal Business Name): OLIVE TREE COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1981 E PALMER WASILLA HWY STE 220
WASILLA AK
99654-7287
US

IV. Provider business mailing address

1981 E PALMER WASILLA HWY STE 220
WASILLA AK
99654-7287
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-6513
  • Fax: 907-354-6514
Mailing address:
  • Phone: 907-357-6513
  • Fax: 907-354-6514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number558
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number770
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number224
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number770
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number224
License Number StateAK
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number558
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHELLY JOAN THOMAS
Title or Position: OWNER
Credential: LMFT
Phone: 907-357-6513