Provider Demographics
NPI:1265910053
Name:MARIEKE OVERMAN PHD
Entity type:Organization
Organization Name:MARIEKE OVERMAN PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-296-8114
Mailing Address - Street 1:27186 NEWPORT RD STE D3
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7386
Mailing Address - Country:US
Mailing Address - Phone:951-296-8114
Mailing Address - Fax:949-336-3847
Practice Address - Street 1:27186 NEWPORT RD STE D3
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7386
Practice Address - Country:US
Practice Address - Phone:951-296-8114
Practice Address - Fax:949-336-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27873OtherLICNSE