Provider Demographics
NPI:1215520036
Name:OVERGAARD, EMILY A (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:OVERGAARD
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 S LAMAR BLVD APT 532
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2585
Mailing Address - Country:US
Mailing Address - Phone:201-546-0226
Mailing Address - Fax:
Practice Address - Street 1:1414 S LAMAR BLVD APT 532
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2585
Practice Address - Country:US
Practice Address - Phone:201-546-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst