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General NPI Number Information
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NPI Number | 1295613651
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH MENTAL HEALTH THERAPY PLLC
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 920 W KING ST STE B
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City | BOONE
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State | NC
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Zip | 28607-3467
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Country | US
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Telephone | 828-278-8282
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Fax | 828-575-5330
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Provider Business Mailing Address
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Address Line | 920 W KING ST STE B
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City | BOONE
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State | NC
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Zip | 28607-3467
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Country | US
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Telephone | 828-278-8282
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. OLIVIA VALLECILLO
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Credential | NCC, LCMHC
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Telephone | 828-278-8282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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