NPIMap

Organization Active NPI

Olive Branch Autism Clinic and Therapy Services LLC

  • Hearing and Speech Clinic/Center
  • Katy, TX
National Provider Identifier
1285136622
Registry record updated Mar 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing and Speech Clinic/CenterTaxonomy code 261QH0700X
License
108185 Issued in TX
Legal business name
OLIVE BRANCH AUTISM CLINIC AND THERAPY SERVICES LLC
Doing business as
Olive Branch Therapy
Practice address
2526 Kinsgate Forest Dr
Katy, TX 77494-1898
Phone
(832) 557-0579
Fax
(832) 553-7719
NPI assigned
Mar 1, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shawna Marie Nickerson, M.A., CCC-SLPNPI 1568976504
Title
Speech Language Pathologist
Phone
(770) 630-6753

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing and Speech Clinic/Center 261QH0700X 108185 TX Primary

Addresses

Primary practice location

2526 Kinsgate Forest Dr
Katy, TX 77494-1898

Mailing address

2526 Kinsgate Forest Dr
Katy, TX 77494-1898
Phone (770) 630-6753

Other names 1

  • Olive Branch Therapy Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552003200000",
    "number": "1285136622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2526 KINSGATE FOREST DR",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774941898",
            "telephone_number": "770-630-6753",
            "fax_number": "832-553-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2526 KINSGATE FOREST DR",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774941898",
            "telephone_number": "832-557-0579",
            "fax_number": "832-553-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE BRANCH AUTISM CLINIC AND THERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-01",
        "last_updated": "2019-03-08",
        "status": "A",
        "authorized_official_last_name": "NICKERSON",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "770-630-6753",
        "authorized_official_credential": "M.A., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "TX",
            "license": "108185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olive Branch Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Katy, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.