Provider Demographics
NPI:1134322209
Name:ONGLEY, GARY T (LPC, LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:T
Last Name:ONGLEY
Suffix:
Gender:M
Credentials:LPC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 RANCHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1534
Mailing Address - Country:US
Mailing Address - Phone:817-919-7351
Mailing Address - Fax:817-336-1740
Practice Address - Street 1:1901 CENTRAL DR
Practice Address - Street 2:STE 315
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5869
Practice Address - Country:US
Practice Address - Phone:817-919-7351
Practice Address - Fax:817-684-9979
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS146891041C0700X
TX9401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1545LCOtherBLUE CROSS BLUESHIELD ID
TX064069001Medicaid
TX014689OtherSTATE LISENCE NUMBER
TX064069001Medicaid
TX064069001Medicaid