OrganizationActive
Olive Branch Behavioral Residencial Network, LLC
NPI 1215574496 · Behavioral Neurology & Neuropsychiatry Physician · Phoenix, AZ
Provider details
- NPI number
- 1215574496
- Entity type
- Organization
- Primary specialty
- Behavioral Neurology & Neuropsychiatry PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Tracy Ketchum, Cao,administrator(708) 277-8673
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(65/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2421 E Robert E Lee St
Phoenix, AZ 85032-1082
Phone: (602) 569-0806
Fax: (602) 569-0537
Street-level locationGet directions
Mailing address
15712 W Eucalyptus Ct
Surprise, AZ 85374-3308
Registry dates
- Enumerated
- 2019-12-05
- Last updated
- 2019-12-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.