Provider Demographics
NPI:1235253204
Name:OVERSTREET, MARCIA M (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:M
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HILLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9508
Mailing Address - Country:US
Mailing Address - Phone:541-482-5460
Mailing Address - Fax:541-482-5460
Practice Address - Street 1:201 W MAIN ST STE 3C
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2744
Practice Address - Country:US
Practice Address - Phone:541-245-9610
Practice Address - Fax:541-245-9629
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health