Basic Information
| Provider Information | |||||||||
| NPI: | 1538675327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OVERTURF | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | MICKY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | BSW/LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2836 LOUISE AVE | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431232464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142739143 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2865 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432042643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148752371 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2017 | ||||||||
| LastUpdateDate: | 12/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1600905 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.