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NPI Code Detail

MEDICARE: TERRENCE WATSON OVERBEY B.A.

MEDICARE: TERRENCE WATSON OVERBEY B.A.
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1427122407
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRENCE WATSON OVERBEY B.A.
Provider Business Mailing Address
First Line : 2865 LOGAN AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92113-2411
Country : US
Telephone Number : 619-232-4357
Fax Number : 619-232-7048
Provider Business Practice Location Address
First Line : 2865 LOGAN AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92113-2411
Country : US
Telephone Number : 619-232-4357
Fax Number : 619-232-7048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 07/08/2007

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