Provider Demographics
NPI:1962394080
Name:OLIVE BRANCH ABA
Entity type:Organization
Organization Name:OLIVE BRANCH ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-552-8207
Mailing Address - Street 1:1985 SWARTHMORE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4554
Mailing Address - Country:US
Mailing Address - Phone:732-503-2368
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR # 26344
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:732-552-8207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty