Provider Demographics
NPI:1215611330
Name:OLIVE BRANCH PSYCHIATRY LLC
Entity type:Organization
Organization Name:OLIVE BRANCH PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:512-550-0079
Mailing Address - Street 1:2806 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-0925
Mailing Address - Country:US
Mailing Address - Phone:303-578-8565
Mailing Address - Fax:
Practice Address - Street 1:35 SE 1ST AVE SUITE 200-O
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-234-3332
Practice Address - Fax:888-352-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty