Provider Demographics
| NPI: | 1063144723 |
|---|---|
| Name: | OVERCOME |
| Entity type: | Organization |
| Organization Name: | OVERCOME |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO/FOUNDER/SERVICE PROVIDER |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | COREY |
| Authorized Official - Middle Name: | MARTEZ |
| Authorized Official - Last Name: | TEAGUE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHD |
| Authorized Official - Phone: | 615-295-2740 |
| Mailing Address - Street 1: | 805 S CHURCH ST STE 17 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MURFREESBORO |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 37130-4917 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 615-295-2740 |
| Mailing Address - Fax: | 615-777-3535 |
| Practice Address - Street 1: | 805 S CHURCH ST STE 17 |
| Practice Address - Street 2: | |
| Practice Address - City: | MURFREESBORO |
| Practice Address - State: | TN |
| Practice Address - Zip Code: | 37130-4917 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 615-295-2740 |
| Practice Address - Fax: | 615-777-3535 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | UNITED RESPONSIBLE FATHERS OF AMERICA |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2022-06-30 |
| Last Update Date: | 2022-06-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YP1600X | Behavioral Health & Social Service Providers | Counselor | Pastoral | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 374K00000X | Nursing Service Related Providers | Religious Nonmedical Practitioner | Group - Multi-Specialty |
