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General NPI Number Information
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NPI Number | 1154245082
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH CLINIC LLC
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Dates
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Enumeration Date | 08/05/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 2000 AUBURN DR STE 200
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City | BEACHWOOD
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State | OH
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Zip | 44122-4328
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Country | US
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Telephone | 216-300-7500
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Fax | 216-300-1900
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Provider Business Mailing Address
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Address Line | 2000 AUBURN DR STE 200
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City | BEACHWOOD
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State | OH
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Zip | 44122-4328
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Country | US
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Telephone | 216-300-7500
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Fax | 216-300-1900
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. TEARA NICOLE YOUNG
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Credential | MSN, PMHNP-BC, DNP-C
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Telephone | 216-300-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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