| Olive Tree Mental Health Llc | |
|
304 S Main St Blanchardville WI 53516-9002 | |
| (608) 341-8600 | |
| (608) 341-8600 |
| Full Name | Olive Tree Mental Health Llc |
|---|---|
| Speciality | Counselor |
| Location | 304 S Main St, Blanchardville, Wisconsin |
| Authorized Official Name and Position | Paulette Marie Wijas (MENTAL HEALTH PROVIDER) |
| Authorized Official Contact | 6083418600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Olive Tree Mental Health Llc 304 S Main St Blanchardville WI 53516-9002 Ph: (608) 341-8600 | Olive Tree Mental Health Llc 304 S Main St Blanchardville WI 53516-9002 Ph: (608) 341-8600 |
| NPI Number | 1750051868 |
|---|---|
| Provider Enumeration Date | 09/20/2021 |
| Last Update Date | 09/20/2021 |
| Certification Date | 09/02/2021 |
| Medicare PECOS PAC ID | 8426446758 |
|---|---|
| Medicare Enrollment ID | O20211019002213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750051868 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Paulette M Wijas Yerges |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366461535 PECOS PAC ID: 9133138043 Enrollment ID: I20060420000136 |
| Provider Name | Jane E Kemnitzer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841228491 PECOS PAC ID: 8921295239 Enrollment ID: I20101213001099 |