Provider Demographics
NPI:1912368564
Name:OVERSTREET, SANDRA (LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-3430
Mailing Address - Country:US
Mailing Address - Phone:765-643-6017
Mailing Address - Fax:
Practice Address - Street 1:501 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-3430
Practice Address - Country:US
Practice Address - Phone:765-643-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist