Provider Demographics
NPI:1629499637
Name:OVERTON PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:OVERTON PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:LEE
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:SUITE 8D
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:
Practice Address - Street 1:8975 S PECOS RD
Practice Address - Street 2:SUITE 8D
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510224Medicaid
NVV12869OtherMEDICARE - PTAN