Provider Demographics
NPI:1861836736
Name:OVERHOLSER, BARBARA ROSE
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ROSE
Last Name:OVERHOLSER
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 1:1028 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2212
Mailing Address - Country:US
Mailing Address - Phone:651-246-2554
Mailing Address - Fax:
Practice Address - Street 1:400 SIBLEY ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1941
Practice Address - Country:US
Practice Address - Phone:651-256-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300428101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)