Provider Demographics
NPI:1619400298
Name:WINSTEAD, OLIVIA NICOLE (BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:NICOLE
Last Name:WINSTEAD
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 TANBARK PL
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2262
Mailing Address - Country:US
Mailing Address - Phone:270-929-8240
Mailing Address - Fax:
Practice Address - Street 1:1000 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-8715
Practice Address - Country:US
Practice Address - Phone:270-689-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100472970Medicaid