Provider Demographics
NPI:1033593595
Name:OVERLY, KIMBERLY A (BCBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:OVERLY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5637-1 LOCKRIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-2673
Mailing Address - Country:US
Mailing Address - Phone:586-588-0253
Mailing Address - Fax:
Practice Address - Street 1:5637-1 LOCKRIDGE LOOP
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-2673
Practice Address - Country:US
Practice Address - Phone:586-588-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-18982103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst