Provider Demographics
NPI:1417116344
Name:OVERSON FAMILY BASED COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:OVERSON FAMILY BASED COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY BASED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:507-327-4064
Mailing Address - Street 1:47205 336TH ST
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MN
Mailing Address - Zip Code:55334-2241
Mailing Address - Country:US
Mailing Address - Phone:507-327-4064
Mailing Address - Fax:507-237-2647
Practice Address - Street 1:47205 336TH ST
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MN
Practice Address - Zip Code:55334-2241
Practice Address - Country:US
Practice Address - Phone:507-327-4064
Practice Address - Fax:507-237-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17672251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA327725700OtherUMPI