Healthcare Provider Details

I. General information

NPI: 1790109189
Provider Name (Legal Business Name): LINDSEY RENAE OVERSTREET LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LINDSEY WARNER

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2084 NE PROFESSIONAL CT
BEND OR
97701-6077
US

IV. Provider business mailing address

600 SW COLUMBIA ST STE 6210
BEND OR
97702-1099
US

V. Phone/Fax

Practice location:
  • Phone: 541-383-3005
  • Fax:
Mailing address:
  • Phone: 541-383-3005
  • Fax: 541-383-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6070
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500669519
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: