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General NPI Number Information
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NPI Number | 1366113334
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Entity Type | Organization
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Legal Business Name | OLIVE TREE COUNSELING LLC
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 306 MIDDLETOWN PARK PL STE B
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City | LOUISVILLE
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State | KY
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Zip | 40243-2517
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Country | US
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Telephone | 606-219-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 926 WILLOW POINTE DR
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City | LOUISVILLE
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State | KY
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Zip | 40299-6604
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAJA CUPAC
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Credential | LPCC
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Telephone | 606-219-2380
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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 |
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License Number State |
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