Olive Branch Behavioral Health

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

OLIVE BRANCH BEHAVIORAL HEALTH

Practice address

1644 W McNeil St
Phoenix, AZ 85041-3762

Phone

(508) 615-7980

NPI assigned

Aug 18, 2022

Organization subpart

No

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

Authorized official

Name

Mary Muthoni Ndungu, NP

Title

Pmhnp-BC

Phone

(508) 615-7980

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1660780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1346968021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1347 E BRIARWOOD TER",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850488691",
            "telephone_number": "508-615-7980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1644 W MCNEIL ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850413762",
            "telephone_number": "508-615-7980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE BRANCH BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-18",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "NDUNGU",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "MUTHONI",
        "authorized_official_title_or_position": "PMHNP-BC",
        "authorized_official_telephone_number": "508-615-7980",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BH7714",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia Michelle Olivas, BCBA
• Amanda Olivas
• Kaitlyn Olivas
• Leslie O'Daniel Olivas, R.N.,B.S.N.
• Saira Maria Olivas, SLPA
• Olive Branch Behavioral Residencial Network, LLC
• Olive Grove Real Estate LLC
• Olive Tree Psychotherapy LLC
• Clay Oliver
• Coy E. Oliver, PNP

• Mental Illness Community Based Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; 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.