Provider Demographics
NPI:1073153904
Name:OVERBROOK COUNSELING LLC
Entity Type:Organization
Organization Name:OVERBROOK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPCC
Authorized Official - Prefix:
Authorized Official - First Name:KACIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PEDON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:614-620-6593
Mailing Address - Street 1:1161 BETHEL RD OFC 5
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2773
Mailing Address - Country:US
Mailing Address - Phone:614-620-6593
Mailing Address - Fax:
Practice Address - Street 1:1161 BETHEL RD OFC 5
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2773
Practice Address - Country:US
Practice Address - Phone:614-620-6593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty