Provider Demographics
NPI:1619373255
Name:OVERHOLTZER, TAMSON (MFT)
Entity Type:Individual
Prefix:MS
First Name:TAMSON
Middle Name:
Last Name:OVERHOLTZER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 HARRISON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4605
Mailing Address - Country:US
Mailing Address - Phone:909-764-8255
Mailing Address - Fax:909-624-7002
Practice Address - Street 1:428 HARRISON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4605
Practice Address - Country:US
Practice Address - Phone:909-764-8255
Practice Address - Fax:909-624-7002
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist