Provider Demographics
NPI:1073686432
Name:OVERHOLT, LINDA SUE (MA LLP LPC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUE
Last Name:OVERHOLT
Suffix:
Gender:F
Credentials:MA LLP LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 N FISHER LN
Mailing Address - Street 2:PO BOX 674
Mailing Address - City:CENTREVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49032
Mailing Address - Country:US
Mailing Address - Phone:269-467-4270
Mailing Address - Fax:269-467-4270
Practice Address - Street 1:338 N FISHER LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MI
Practice Address - Zip Code:49032
Practice Address - Country:US
Practice Address - Phone:268-467-4270
Practice Address - Fax:269-467-4270
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000728101Y00000X
MI6301005889103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOVERH6598Medicaid