MEDICARE: MICHAELA OVERLEY BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-23-67071	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326611245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA OVERLEY BCBA

Provider Business Mailing Address
First Line	:	701 WELLINGTON HILLS RD APT 721
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2181
Country	:	US
Telephone Number	:	720-209-6194
Fax Number	:

Provider Business Practice Location Address
First Line	:	4610 W COMMERCIAL DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7057
Country	:	US
Telephone Number	:	501-287-5229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	10/04/2024

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