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General NPI Number Information
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NPI Number | 1962394080
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH ABA
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 10101 FONDREN RD STE 540
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City | HOUSTON
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State | TX
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Zip | 77096-5148
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Country | US
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Telephone | 512-333-4539
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Fax |
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Provider Business Mailing Address
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Address Line | 1985 SWARTHMORE AVE STE 4
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4554
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Country | US
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Telephone | 732-503-2368
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MINDY TOMOR
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Credential |
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Telephone | 732-552-8207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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