Healthcare Provider Details

I. General information

NPI: 1285585968
Provider Name (Legal Business Name): THE OLIVE BRANCH THERAPEUTIC PLAY AND PLAY CAFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 ASHWOOD AVE
ELIZABETHTOWN KY
42701-4908
US

IV. Provider business mailing address

413 ASHWOOD AVE
ELIZABETHTOWN KY
42701-4908
US

V. Phone/Fax

Practice location:
  • Phone: 270-307-4151
  • Fax:
Mailing address:
  • Phone: 270-307-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTEN DOWELL ARGUEDAS
Title or Position: OWNER
Credential: LPCC
Phone: 270-307-4151