Provider Demographics
NPI:1578185856
Name:OVERTON, BRIANNE L (FT, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:BRIANNE
Middle Name:L
Last Name:OVERTON
Suffix:
Gender:F
Credentials:FT, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N 7TH ST APT 810
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-1330
Mailing Address - Country:US
Mailing Address - Phone:314-221-2964
Mailing Address - Fax:
Practice Address - Street 1:3115 S GRAND BLVD STE 400
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1048
Practice Address - Country:US
Practice Address - Phone:314-221-2964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010125101Y00000X
MO2017025360101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor