MEDICARE: MR. JOHN TYLER OVERSTREET LSPE, LPC

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	101YP2500X	Professional Counselor	LPC422	TN
2	103T00000X	Psychologist	PE1317	TN

General Provider Information

NPI Number	:	1497729701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN TYLER OVERSTREET LSPE, LPC

Provider Business Mailing Address
First Line	:	PO BOX 966
Second Line	:
City	:	KINGSTON
State	:	TN
Zip	:	37763-0966
Country	:	US
Telephone Number	:	865-376-9879
Fax Number	:	865-717-2777

Provider Business Practice Location Address
First Line	:	111 CENTER PARK DR
Second Line	:	SUITE 1300
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2103
Country	:	US
Telephone Number	:	865-693-9997
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	09/11/2025

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