Healthcare Provider Details

I. General information

NPI: 1336436914
Provider Name (Legal Business Name): LINDA OVERBY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 ROSE PETAL CT
HENDERSON NV
89012-2205
US

IV. Provider business mailing address

329 ROSE PETAL CT
HENDERSON NV
89012-2205
US

V. Phone/Fax

Practice location:
  • Phone: 702-277-7703
  • Fax: 702-433-8864
Mailing address:
  • Phone: 702-277-7703
  • Fax: 702-433-8864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number#0622
License Number StateNV

VIII. Authorized Official

Name: MRS. LINDA J. OVERBY
Title or Position: COUNSELOR/PSR
Credential: EDS, MS
Phone: 702-277-7703