Provider Demographics
NPI:1235661406
Name:OVERTON PSYCHOLOGICAL SERVICE
Entity Type:Organization
Organization Name:OVERTON PSYCHOLOGICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:702-563-1000
Mailing Address - Street 1:8975 S PECOS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7160
Mailing Address - Country:US
Mailing Address - Phone:702-563-1000
Mailing Address - Fax:702-563-1001
Practice Address - Street 1:8975 S PECOS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7160
Practice Address - Country:US
Practice Address - Phone:702-563-1000
Practice Address - Fax:702-563-1001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service