=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780569723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLIVE TREE THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2025
-----------------------------------------------------
Last Update Date | 08/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1223 N ROCK RD BUILDING A SUITE 100
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-1271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-512-1486
-----------------------------------------------------
Fax | 316-235-2490
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1223 N ROCK RD BUILDING A SUITE 100
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-1271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-512-1486
-----------------------------------------------------
Fax | 316-235-2490
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TAYLOR HAIG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 316-832-5641
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------