Healthcare Provider Details

I. General information

NPI: 1194647115
Provider Name (Legal Business Name): OLIVE BRANCH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10596 SCARLET OAK DR
YPSILANTI MI
48198-1330
US

IV. Provider business mailing address

46036 MICHIGAN AVE
CANTON MI
48188-2304
US

V. Phone/Fax

Practice location:
  • Phone: 734-891-0362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HANI MOHAMMED
Title or Position: FOUNDER
Credential: LMSW
Phone: 734-891-0362