Provider Demographics
NPI:1891164836
Name:OVERTON, DANIELLE (PHD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:OVERTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11059 E BETHANY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2637
Mailing Address - Country:US
Mailing Address - Phone:303-617-2300
Mailing Address - Fax:303-617-2365
Practice Address - Street 1:11059 E BETHANY DR STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2637
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:303-617-2365
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COPSY.0004905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health