NPIMap

Organization Active NPI

Olive Branch Counseling Associates, Inc.

  • Mental Health Counselor
  • Oak Forest, IL
National Provider Identifier
1730124157
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
OLIVE BRANCH COUNSELING ASSOCIATES, INC.
Practice address
15601 Cicero Ave
Suite 103
Oak Forest, IL 60452-3635
Phone
(708) 687-3479
Fax
(708) 687-3480
NPI assigned
Jun 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Louella Beth Devries, M.A.NPI 1710091582
Title
President
Phone
(708) 687-3479

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
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

15601 Cicero Ave
Suite 103
Oak Forest, IL 60452-3635

Mailing address

15601 Cicero Ave
Suite 103
Oak Forest, IL 60452-3635
Phone (708) 687-3479

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060725000257 IL Part B Supplier - Clinic/Group Practice 2062425754 Receives reassigned benefits from 3 practitioners
Practice locations: Tinley Park, IL

National Provider Directory

National Provider Directory
Tax ID family
Olive Branch Counseling Associates Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15601 Cicero Ave
Ste 103
Oak Forest, IL 60452
Phone (708) 207-0127

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730124157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15601 CICERO AVE",
            "address_2": "SUITE 103",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604523635",
            "telephone_number": "708-687-3479",
            "fax_number": "708-687-3480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15601 CICERO AVE",
            "address_2": "SUITE 103",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604523635",
            "telephone_number": "708-687-3479",
            "fax_number": "708-687-3480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE BRANCH COUNSELING ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEVRIES",
        "authorized_official_first_name": "LOUELLA",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-687-3479",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.