Provider Demographics
NPI:1053527036
Name:OVERHOLT, BERT ALAN (MA)
Entity type:Individual
Prefix:MR
First Name:BERT
Middle Name:ALAN
Last Name:OVERHOLT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21243 VENTURA BLVD.
Mailing Address - Street 2:SUITE 121
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2162
Mailing Address - Country:US
Mailing Address - Phone:818-883-9962
Mailing Address - Fax:818-883-9963
Practice Address - Street 1:21243 VENTURA BLVD.
Practice Address - Street 2:SUITE 121
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2162
Practice Address - Country:US
Practice Address - Phone:818-883-9962
Practice Address - Fax:818-883-9963
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 24591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist