Provider Demographics
NPI:1841033560
Name:OVERHULS, JILL LEIGH
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:LEIGH
Last Name:OVERHULS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 S VANDALIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-5229
Mailing Address - Country:US
Mailing Address - Phone:918-812-9957
Mailing Address - Fax:
Practice Address - Street 1:324 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-2532
Practice Address - Country:US
Practice Address - Phone:918-279-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty