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NPI Code Detail

MEDICARE: DENEAN LYNN OVERTON-RUSSELL

MEDICARE: DENEAN LYNN OVERTON-RUSSELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianA1896003CA
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1003382144
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENEAN LYNN OVERTON-RUSSELL
Provider Business Mailing Address
First Line : 1063 MCGAW AVE STE 100
Second Line :
City : IRVINE
State : CA
Zip : 92614-5554
Country : US
Telephone Number : 323-454-7937
Fax Number : 323-292-0053
Provider Business Practice Location Address
First Line : 1333 S MAYFLOWER AVE STE 220
Second Line :
City : MONROVIA
State : CA
Zip : 91016-5239
Country : US
Telephone Number : 888-805-0759
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2018
Last Update Date : 12/19/2022

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Directions to “ DENEAN LYNN OVERTON-RUSSELL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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