Healthcare Provider Details

I. General information

NPI: 1871421362
Provider Name (Legal Business Name): OLIVELEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MAPLE ST 144
SOAP LAKE WA
98851
US

IV. Provider business mailing address

PO BOX 144
SOAP LAKE WA
98851-0144
US

V. Phone/Fax

Practice location:
  • Phone: 509-361-4643
  • Fax:
Mailing address:
  • Phone: 509-361-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMY J COUNTRYMAN
Title or Position: OWNER/LICSW
Credential: LICSW
Phone: 530-255-4761