=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003781600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLIVE BRANCH FAMILY THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2025
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 621 W ADAMS BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90007-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-819-5713
-----------------------------------------------------
Fax | 951-944-2351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36770 AMATEUR WAY ADDRESS 2 (OPTIONAL)
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92223-8111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-819-5713
-----------------------------------------------------
Fax | 951-944-2351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMFT
-----------------------------------------------------
Name | MS. ANNA TOPUZOGLU
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 323-819-5713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------