Provider Demographics
NPI:1952459398
Name:OVERIN, FORREST MICAH (LMFT)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:MICAH
Last Name:OVERIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 HARDING ST
Mailing Address - Street 2:#112
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1818
Mailing Address - Country:US
Mailing Address - Phone:760-434-1941
Mailing Address - Fax:760-433-1941
Practice Address - Street 1:2945 HARDING ST
Practice Address - Street 2:#112
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1818
Practice Address - Country:US
Practice Address - Phone:760-434-1941
Practice Address - Fax:760-433-1941
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 20617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health