Provider Demographics
NPI:1205638061
Name:OVERSHINER, KAYLEA LEANNE
Entity type:Individual
Prefix:
First Name:KAYLEA
Middle Name:LEANNE
Last Name:OVERSHINER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2922
Mailing Address - Country:US
Mailing Address - Phone:812-569-3104
Mailing Address - Fax:
Practice Address - Street 1:3209 W SMITH VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-8495
Practice Address - Country:US
Practice Address - Phone:812-569-3104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-206919103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst