Provider Demographics
NPI:1710040902
Name:OVERSTREET, DAVID L (PH D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:OVERSTREET
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 GRAHAM RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8029
Mailing Address - Country:US
Mailing Address - Phone:314-831-7774
Mailing Address - Fax:314-831-2775
Practice Address - Street 1:1281 GRAHAM RD
Practice Address - Street 2:SUITE 305
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8029
Practice Address - Country:US
Practice Address - Phone:314-831-7774
Practice Address - Fax:314-831-2775
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01765103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496832528Medicaid
MO000071253Medicare ID - Type Unspecified