Provider Demographics
NPI:1770158495
Name:OVERSTREET, BRANDON (LPN)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:OVERSTREET
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MEADOW SLOPE DR
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-8693
Mailing Address - Country:US
Mailing Address - Phone:541-621-7232
Mailing Address - Fax:
Practice Address - Street 1:149 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535-6631
Practice Address - Country:US
Practice Address - Phone:154-153-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health