MEDICARE: LADY L OVERSHOWN

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1477080463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LADY L OVERSHOWN

Provider Business Mailing Address
First Line	:	7430 ELDERBERRY LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75249-1044
Country	:	US
Telephone Number	:	214-505-7398
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 ELDERBERRY LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75249-1044
Country	:	US
Telephone Number	:	214-505-7398
Fax Number	:

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

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	04/26/2026

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Directions to “ LADY L OVERSHOWN ” Practice Location

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