Healthcare Provider Details

I. General information

NPI: 1750051868
Provider Name (Legal Business Name): OLIVE TREE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S MAIN ST
BLANCHARDVILLE WI
53516-9002
US

IV. Provider business mailing address

304 S MAIN ST P O BOX 145
BLANCHARDVILLE WI
53516-9002
US

V. Phone/Fax

Practice location:
  • Phone: 608-341-8600
  • Fax: 608-341-8600
Mailing address:
  • Phone: 608-636-4328
  • Fax: 608-523-1111

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: PAULETTE M WIJAS YERGES
Title or Position: OWNER
Credential: LCSW
Phone: 608-636-4328