Healthcare Provider Details

I. General information

NPI: 1598030942
Provider Name (Legal Business Name): DONA OVERBAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 HARBOR RD
GROVE OK
74344-3505
US

IV. Provider business mailing address

1115 HARBOR RD
GROVE OK
74344-3505
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-4434
  • Fax: 918-786-4434
Mailing address:
  • Phone: 918-786-4434
  • Fax: 918-786-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: