Individual
MIKAELA OVERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1075 E PARK BLVD, BOISE, ID 83712-7722
(208) 381-5970
(208) 381-5971
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6261175
ID
103T00000X
Psychologist
6352000475
MI
Other
Enumeration date
10/19/2020
Last updated
08/22/2024
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