Provider Demographics
NPI:1528512183
Name:OLIVE BRANCH PSYCHIATRY
Entity type:Organization
Organization Name:OLIVE BRANCH PSYCHIATRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-451-3454
Mailing Address - Street 1:13821 TECHNOLOGY DR STE B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1046
Mailing Address - Country:US
Mailing Address - Phone:405-451-3454
Mailing Address - Fax:405-543-7359
Practice Address - Street 1:13821 TECHNOLOGY DR STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1046
Practice Address - Country:US
Practice Address - Phone:405-451-3454
Practice Address - Fax:405-451-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty