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General NPI Number Information
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NPI Number | 1013307966
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH COUNSELING AND TRAINING, PLLC
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 31320 INTERSTATE 10 W SUITE E
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City | BOERNE
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State | TX
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Zip | 78006-5027
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Country | US
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Telephone | 210-564-4310
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Fax | 830-775-2369
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Provider Business Mailing Address
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Address Line | 31320 INTERSTATE 10 W SUITE E
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City | BOERNE
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State | TX
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Zip | 78006-5027
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Country | US
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Telephone | 210-564-4310
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Fax | 830-775-2369
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Authorized Official
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Title or Position | OWNER
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Name | MS. AMY WILSON
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Credential | MA, LPC
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Telephone | 210-564-4310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 70073
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License Number State | TX
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