Provider Demographics
NPI:1528209525
Name:LATRICE T OGLESBY
Entity Type:Organization
Organization Name:LATRICE T OGLESBY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:TONIAS
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-268-1749
Mailing Address - Street 1:1628 216TH PL
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-4480
Mailing Address - Country:US
Mailing Address - Phone:708-268-1749
Mailing Address - Fax:
Practice Address - Street 1:17019 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2739
Practice Address - Country:US
Practice Address - Phone:708-268-1749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007113251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health