Provider Demographics
NPI:1124877097
Name:OLIVEPATH PSYCHIATRY SERVICES PLLC
Entity type:Organization
Organization Name:OLIVEPATH PSYCHIATRY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:U
Authorized Official - Last Name:EJEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-856-2411
Mailing Address - Street 1:11015 RAINY CANYON LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1699
Mailing Address - Country:US
Mailing Address - Phone:708-616-1477
Mailing Address - Fax:832-321-2895
Practice Address - Street 1:13500 W AIRPORT BLVD STE B
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-6319
Practice Address - Country:US
Practice Address - Phone:708-616-1477
Practice Address - Fax:832-321-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty