Provider Demographics
NPI:1083385827
Name:OVERSON, BECKY SUE
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:SUE
Last Name:OVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 NE HWY 20
Mailing Address - Street 2:SUITE 610 MBN 437
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3572
Mailing Address - Country:US
Mailing Address - Phone:541-908-0349
Mailing Address - Fax:
Practice Address - Street 1:2902 NE JACKDAW DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7735
Practice Address - Country:US
Practice Address - Phone:541-908-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORA127561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health