Healthcare Provider Details

I. General information

NPI: 1093239907
Provider Name (Legal Business Name): ELIZABETH ANN OVERPECK MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 10/13/2026
Certification Date: 10/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 SHELLIE RD STE 13
JACKSONVILLE FL
32257-6174
US

IV. Provider business mailing address

3091 DANUBE CT
JACKSONVILLE FL
32246-5513
US

V. Phone/Fax

Practice location:
  • Phone: 850-445-3045
  • Fax:
Mailing address:
  • Phone: 850-445-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH20147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: