Provider Demographics
NPI:1952611477
Name:OVERTON, SIERRA RAE (BA)
Entity type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:RAE
Last Name:OVERTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:SIERRA
Other - Middle Name:RAE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1743 ROCHELLE WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANO
Mailing Address - State:CA
Mailing Address - Zip Code:93445
Mailing Address - Country:US
Mailing Address - Phone:805-588-5435
Mailing Address - Fax:
Practice Address - Street 1:1743 ROCHELLE WAY
Practice Address - Street 2:
Practice Address - City:OCEANO
Practice Address - State:CA
Practice Address - Zip Code:93445
Practice Address - Country:US
Practice Address - Phone:805-588-5435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health