Provider Demographics
NPI:1841443884
Name:OVERTON, JENNIFER (LCSW, LMSW-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:OVERTON
Suffix:
Gender:F
Credentials:LCSW, LMSW-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:OVERTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW, LMSW-C
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:EMPIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49630-0482
Mailing Address - Country:US
Mailing Address - Phone:231-256-1167
Mailing Address - Fax:231-525-2147
Practice Address - Street 1:120 E FRONT ST STE 2
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2668
Practice Address - Country:US
Practice Address - Phone:231-256-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011018921041C0700X
SC141391041C0700X
NCC0072661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical