MEDICARE: MARCIA M OVERSTREET MS, LPC

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
1	101YM0800X	Mental Health Counselor	C1733	OR

General Provider Information

NPI Number	:	1235253204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA M OVERSTREET MS, LPC

Provider Business Mailing Address
First Line	:	70 HILLENDALE DR
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-9508
Country	:	US
Telephone Number	:	541-482-5460
Fax Number	:	541-482-5460

Provider Business Practice Location Address
First Line	:	201 W MAIN ST STE 3C
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-2744
Country	:	US
Telephone Number	:	541-245-9610
Fax Number	:	541-245-9629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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