Organization
OVERSTREET PSYCHOLOGY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVE L. OVERSTREET PH.D. (OWNER)
(314) 831-7774
Entity
Organization
Contact information
Practice address
1150 GRAHAM RD, SUITE 115, FLORISSANT, MO 63031-8077
(314) 831-7774
(314) 831-2775
Mailing address
1150 GRAHAM RD, SUITE 115, FLORISSANT, MO 63031-8077
(314) 831-7774
(314) 831-2775
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
01765
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
990001701
MEDICARE GROUP
MO
Enumeration date
01/10/2008
Last updated
10/20/2011
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