Healthcare Provider Details

I. General information

NPI: 1881392124
Provider Name (Legal Business Name): OVERCOME COUNSELING, COACHING, & CONFLICT RESOLUTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 DEVON CIR
ST AUGUSTINE FL
32086-8704
US

IV. Provider business mailing address

530 DEVON CIR
ST AUGUSTINE FL
32086-8704
US

V. Phone/Fax

Practice location:
  • Phone: 817-691-4039
  • Fax:
Mailing address:
  • Phone: 817-691-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA MICHELE HOUGHTON
Title or Position: CEO
Credential: LCSW
Phone: 817-691-4039