Provider Demographics
NPI:1114752912
Name:OVERBEY, JOHN PADEN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PADEN
Last Name:OVERBEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W BLAIR ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-1607
Mailing Address - Country:US
Mailing Address - Phone:903-630-0071
Mailing Address - Fax:
Practice Address - Street 1:406 W BLAIR ST STE 400
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1607
Practice Address - Country:US
Practice Address - Phone:903-630-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health