Provider Demographics
NPI:1295975597
Name:OVERBAY, ILDIKO M
Entity type:Individual
Prefix:
First Name:ILDIKO
Middle Name:M
Last Name:OVERBAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ILDIKO
Other - Middle Name:
Other - Last Name:HORVATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:760 SW MADISON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4590
Mailing Address - Country:US
Mailing Address - Phone:541-231-5067
Mailing Address - Fax:888-834-1961
Practice Address - Street 1:760 SW MADISON AVE STE 204
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4590
Practice Address - Country:US
Practice Address - Phone:541-231-5067
Practice Address - Fax:888-834-1961
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCADCI 03-11-39101YA0400X
ORC2292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)