| Olive Branch Counseling Associates, Inc. | |
|
15601 Cicero Ave Suite 103 Oak Forest IL 60452-3635 | |
| (708) 687-3479 | |
| (708) 687-3480 |
| Full Name | Olive Branch Counseling Associates, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 15601 Cicero Ave, Oak Forest, Illinois |
| Authorized Official Name and Position | Louella Beth Devries (PRESIDENT) |
| Authorized Official Contact | 7086873479 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Olive Branch Counseling Associates, Inc. 15601 Cicero Ave Suite 103 Oak Forest IL 60452-3635 Ph: (708) 687-3479 | Olive Branch Counseling Associates, Inc. 15601 Cicero Ave Suite 103 Oak Forest IL 60452-3635 Ph: (708) 687-3479 |
| NPI Number | 1730124157 |
|---|---|
| Provider Enumeration Date | 06/19/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2062425754 |
|---|---|
| Medicare Enrollment ID | O20060725000257 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730124157 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Michael J Devries |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881621951 PECOS PAC ID: 7315921418 Enrollment ID: I20040616000535 |
| Provider Name | Kara E Wolff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659651438 PECOS PAC ID: 2365605557 Enrollment ID: I20120525000612 |
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