NPIMap

Organization Active NPI

Olive Leaf Family Therapy, Inc

  • Marriage & Family Therapist
  • Fresno, CA
National Provider Identifier
1447816079
Registry record updated Oct 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
OLIVE LEAF FAMILY THERAPY, INC
Practice address
6276 N 1St St Ste 103
Fresno, CA 93710-5400
Phone
(559) 712-4300
Fax
(559) 412-2104
NPI assigned
May 20, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2019

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

Authorized official

Name
Laura Alice Slagle, LMFTNPI 1922255199
Title
Ceo, Clinical Director
Phone
(559) 970-8831

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
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

6276 N 1St St Ste 103
Fresno, CA 93710-5400

Mailing address

6276 N 1St St Ste 103
Fresno, CA 93710-5400
Phone (559) 712-4300

Other practice location 1

6276 N 1st St Ste 105
Fresno, CA 93710-5400
Phone (559) 712-4300

Other practice location 2

1040 E Herndon Ave Ste 101
Fresno, CA 93720-3158
Phone (559) 712-4300

Other identifiers 1

IdentifierTypeStateIssuer
83605OtherCACA BOARD OF BEHAVIORAL SCIENCES

Other names 1

  • LAURA SLAGLE, LMFT Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241002000768 CA Part B Supplier - Clinic/Group Practice 7810428851 Receives reassigned benefits from 8 practitioners
Practice locations: Fresno, CA; Long Beach, CA

National Provider Directory

National Provider Directory

Locations

1040 E Herndon Ave
Ste 101
Fresno, CA 93720
Phone (559) 422-0077

6276 N 1st St
Ste 103
Fresno, CA 93710
Phone (559) 530-2822

6621 E Pacific Coast Hwy
Ste 220
Long Beach, CA 90803
Phone (562) 858-0663

5150 E Pacific Coast Hwy
Ste 200
Long Beach, CA 90804
Phone (562) 285-3542

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572307200000",
    "number": "1447816079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6276 N 1ST ST STE 103",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105400",
            "telephone_number": "559-712-4300",
            "fax_number": "559-412-2104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6276 N 1ST ST STE 103",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105400",
            "telephone_number": "559-712-4300",
            "fax_number": "559-412-2104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6276 N 1st St Ste 105",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937105400",
            "country_code": "US",
            "telephone_number": "559-712-4300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1040 E Herndon Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937203158",
            "country_code": "US",
            "telephone_number": "559-712-4300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OLIVE LEAF FAMILY THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-20",
        "last_updated": "2019-10-29",
        "status": "A",
        "authorized_official_last_name": "SLAGLE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "ALICE",
        "authorized_official_title_or_position": "CEO, CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "559-970-8831",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA BOARD OF BEHAVIORAL SCIENCES",
            "identifier": "83605",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAURA SLAGLE, LMFT",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "LAURA SLAGLE, LMFT",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.