The Extended Olive Branch Counseling Center LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

THE EXTENDED OLIVE BRANCH COUNSELING CENTER LLC

Practice address

16320 Huebner Rd Ste 200
San Antonio, TX 78248-1690

Phone

(830) 443-0553

Fax

(830) 215-0223

NPI assigned

Sep 1, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Joshua T Garcia

Title

President

Phone

(830) 443-0553

Specialties & licenses 2

Addresses

Locations

Practitioners 2

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

• Charles Wayne Jackson, LPC

  • Professional Counselor
  • San Antonio, TX
  • NPI 1871742791
  NPD
• Demetrius Walton, LMFT

  • Marriage & Family Therapist
  • Salado, TX
  • NPI 1649934506
  NPD (past)

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1619645975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16320 HUEBNER RD STE 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782481690",
            "telephone_number": "830-443-0553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16320 HUEBNER RD STE 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782481690",
            "telephone_number": "830-443-0553",
            "fax_number": "830-215-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EXTENDED OLIVE BRANCH COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "830-443-0553",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in San Antonio, TX
• Mental Health Clinic/Center (Including Community Mental Health Center) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; 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.