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NPI Code Detail

MEDICARE: OLIVE BRANCH BEHAVIORAL HEALTH COUNSELING SERVICES, INC

MEDICARE: OLIVE BRANCH BEHAVIORAL HEALTH COUNSELING SERVICES, INC
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
1101Y00000XCounselor6747OK

General Provider Information

NPI Number : 1538657572
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLIVE BRANCH BEHAVIORAL HEALTH COUNSELING SERVICES, INC
Provider Business Mailing Address
First Line : PO BOX 589
Second Line :
City : TECUMSEH
State : OK
Zip : 74873-0589
Country : US
Telephone Number : 405-585-3833
Fax Number : 405-598-6770
Provider Business Practice Location Address
First Line : 602 N BROADWAY ST
Second Line :
City : TECUMSEH
State : OK
Zip : 74873-2020
Country : US
Telephone Number : 405-585-3833
Fax Number : 405-598-6770
Authorized Official
Title or Position : LICENSED PROFESSIOAL COUNSELOR
Name : MRS. ANGELA LACYNDA PHILLIPS
Credential : M.HR
Telephone Number : 405-296-3334
Provider Enumeration Date : 04/25/2018
Last Update Date : 03/17/2026

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