MEDICARE: DEZEE OVERSTREET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	7888	TX

General Provider Information

NPI Number	:	1538973888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEZEE OVERSTREET

Provider Business Mailing Address
First Line	:	6105 YELLOW ROSE CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1657
Country	:	US
Telephone Number	:	972-777-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 YELLOW ROSE CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1657
Country	:	US
Telephone Number	:	972-777-1331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	02/06/2025

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Directions to “ DEZEE OVERSTREET ” Practice Location

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