Healthcare Provider Details

I. General information

NPI: 1619895810
Provider Name (Legal Business Name): LORI DEEANN OVERHOLSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 FAR HILLS AVE
KETTERING OH
45429-2386
US

IV. Provider business mailing address

5450 FAR HILLS AVE
KETTERING OH
45429-2386
US

V. Phone/Fax

Practice location:
  • Phone: 937-299-9060
  • Fax:
Mailing address:
  • Phone: 937-299-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2608139
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: