Provider Demographics
NPI:1942480025
Name:OVERSTREET, MARTIN DEE (MFT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:DEE
Last Name:OVERSTREET
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 BOEING AVE
Mailing Address - Street 2:SUITE A5
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-9371
Mailing Address - Country:US
Mailing Address - Phone:707-601-8454
Mailing Address - Fax:707-633-5592
Practice Address - Street 1:3135 BOEING AVE
Practice Address - Street 2:SUITE A5
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-9371
Practice Address - Country:US
Practice Address - Phone:707-601-8454
Practice Address - Fax:707-633-5592
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist