Provider Demographics
NPI:1639417348
Name:REESE-OVERSTREET, ANGELICA MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:MARIE
Last Name:REESE-OVERSTREET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-2124
Mailing Address - Country:US
Mailing Address - Phone:405-762-6603
Mailing Address - Fax:
Practice Address - Street 1:2409 N MONROE ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-2124
Practice Address - Country:US
Practice Address - Phone:405-762-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst