Provider Demographics
NPI:1730679127
Name:OLIVET BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:OLIVET BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-458-1759
Mailing Address - Street 1:3002 OLDE TABBY DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-9223
Mailing Address - Country:US
Mailing Address - Phone:678-458-1759
Mailing Address - Fax:
Practice Address - Street 1:8336 OFFICE PARK DR STE K
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6937
Practice Address - Country:US
Practice Address - Phone:678-458-1759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty