Provider Demographics
NPI:1336436914
Name:LINDA OVERBY
Entity Type:Organization
Organization Name:LINDA OVERBY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/PSR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OVERBY
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, MS
Authorized Official - Phone:702-277-7703
Mailing Address - Street 1:329 ROSE PETAL CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2205
Mailing Address - Country:US
Mailing Address - Phone:702-277-7703
Mailing Address - Fax:702-433-8864
Practice Address - Street 1:329 ROSE PETAL CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-2205
Practice Address - Country:US
Practice Address - Phone:702-277-7703
Practice Address - Fax:702-433-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV#0622302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1760623045Medicaid