Provider Demographics
NPI:1760356539
Name:OLIVE BRANCH BEHAVIOR THERAPY
Entity type:Organization
Organization Name:OLIVE BRANCH BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT SUPPORT PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:SAHARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-800-7777
Mailing Address - Street 1:3645 MADISON WATCH WAY
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6399 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5093
Practice Address - Country:US
Practice Address - Phone:571-800-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)