Provider Demographics
NPI:1831385806
Name:OVERBAUGH, JEREMY S (LMSW)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:S
Last Name:OVERBAUGH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:S
Other - Last Name:OVERBAUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2300
Mailing Address - Fax:515-241-2305
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2300
Practice Address - Fax:515-241-2305
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06285104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker