MEDICARE: OLIVELEAF

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1871421362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVELEAF

Provider Business Mailing Address
First Line	:	PO BOX 144
Second Line	:
City	:	SOAP LAKE
State	:	WA
Zip	:	98851-0144
Country	:	US
Telephone Number	:	509-361-4643
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 MAPLE ST 144
Second Line	:
City	:	SOAP LAKE
State	:	WA
Zip	:	98851
Country	:	US
Telephone Number	:	509-361-4643
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LICSW
Name	:	TAMMY J COUNTRYMAN
Credential	:
Telephone Number	:	530-255-4761

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Directions to “OLIVELEAF ” Practice Location

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