Provider Demographics
NPI:1194822577
Name:OVERTON, JARED LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:LEE
Last Name:OVERTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1696
Mailing Address - Street 2:
Mailing Address - City:OVERTON
Mailing Address - State:NV
Mailing Address - Zip Code:89040-1696
Mailing Address - Country:US
Mailing Address - Phone:702-397-2900
Mailing Address - Fax:702-397-2915
Practice Address - Street 1:145 S. MOAPA VALLEY BLVD.
Practice Address - Street 2:SUITE 2
Practice Address - City:OVERTON
Practice Address - State:NV
Practice Address - Zip Code:89040
Practice Address - Country:US
Practice Address - Phone:702-397-2900
Practice Address - Fax:702-397-2915
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical