Provider Demographics
NPI:1437741287
Name:OVERTURF, ALYSSA ROSE (NCSP, EDS)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ROSE
Last Name:OVERTURF
Suffix:
Gender:F
Credentials:NCSP, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 N MAPLEWOOD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2857
Mailing Address - Country:US
Mailing Address - Phone:952-449-1375
Mailing Address - Fax:
Practice Address - Street 1:42 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4309
Practice Address - Country:US
Practice Address - Phone:773-553-4748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2454794103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool