MEDICARE: OLIVE BRANCH FAMILY THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1003781600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE BRANCH FAMILY THERAPY

Provider Business Mailing Address
First Line	:	36770 AMATEUR WAY
Second Line	:	ADDRESS 2 (OPTIONAL)
City	:	BEAUMONT
State	:	CA
Zip	:	92223-8111
Country	:	US
Telephone Number	:	323-819-5713
Fax Number	:	951-944-2351

Provider Business Practice Location Address
First Line	:	621 W ADAMS BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2546
Country	:	US
Telephone Number	:	323-819-5713
Fax Number	:	951-944-2351

Authorized Official
Title or Position	:	LMFT
Name	:	MS. ANNA TOPUZOGLU
Credential	:	MS
Telephone Number	:	323-819-5713

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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