Provider Demographics
NPI:1497729701
Name:OVERSTREET, JOHN TYLER (LSPE, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TYLER
Last Name:OVERSTREET
Suffix:
Gender:M
Credentials:LSPE, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-0966
Mailing Address - Country:US
Mailing Address - Phone:865-376-9879
Mailing Address - Fax:865-717-2777
Practice Address - Street 1:111 CENTER PARK DR
Practice Address - Street 2:SUITE 1300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2103
Practice Address - Country:US
Practice Address - Phone:865-693-9997
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC422101YP2500X
TNPE1317103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist