Healthcare Provider Details

I. General information

NPI: 1831251909
Provider Name (Legal Business Name): DANIEL RICHARD OVERTON NCC,MC,LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 SUMNER AVE
ABERDEEN WA
98520-4600
US

IV. Provider business mailing address

539 E CHANCE A LA MER NE
OCEAN SHORES WA
98569-9103
US

V. Phone/Fax

Practice location:
  • Phone: 360-538-1461
  • Fax:
Mailing address:
  • Phone: 360-589-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00008003
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 828
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: