Organization
OLIVE BRANCH WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN L FELTON (OWNER)
(813) 522-1690
Entity
Organization
Contact information
Practice address
4144 N. ARMENIA AVE, SUITE 350, TAMPA, FL 33607
(813) 522-1690
Mailing address
4144 N. ARMENIA AVE, SUITE 350, TAMPA, FL 33607
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IMH16103
STATE OF FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
05/30/2019
Last updated
05/30/2019
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