Organization
OLIVE BRANCH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCELYN WILSON LMHC (OWNER DIRECTOR)
(317) 500-4266
Entity
Organization
Contact information
Practice address
4954 E 56TH ST, INDIANAPOLIS, IN 46220-5773
(317) 500-4266
Mailing address
6509 CHERBOURG CIR, INDIANAPOLIS, IN 46220-6014
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
1041S0200X
School Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790917060
—
IN
Enumeration date
10/18/2018
Last updated
08/18/2020
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