Healthcare Provider Details

I. General information

NPI: 1154245082
Provider Name (Legal Business Name): OLIVE BRANCH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 AUBURN DR STE 200
BEACHWOOD OH
44122-4328
US

IV. Provider business mailing address

2000 AUBURN DR STE 200
BEACHWOOD OH
44122-4328
US

V. Phone/Fax

Practice location:
  • Phone: 216-300-7500
  • Fax: 216-300-1900
Mailing address:
  • Phone: 216-300-7500
  • Fax: 216-300-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. TEARA NICOLE YOUNG
Title or Position: OWNER/PROVIDER
Credential: MSN, PMHNP-BC, DNP-C
Phone: 216-300-7500