Provider Demographics
NPI:1982208773
Name:OLIVE COUNSELING LLC
Entity type:Organization
Organization Name:OLIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCPC
Authorized Official - Phone:312-883-4077
Mailing Address - Street 1:9978 57TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3428
Mailing Address - Country:US
Mailing Address - Phone:312-883-4077
Mailing Address - Fax:
Practice Address - Street 1:1700 66TH ST N # 104-312
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5544
Practice Address - Country:US
Practice Address - Phone:312-883-4077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty