Provider Demographics
NPI:1578961934
Name:OGLE, NICK (PHD)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:OGLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ENTERPRISE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8975
Mailing Address - Country:US
Mailing Address - Phone:479-717-7626
Mailing Address - Fax:479-717-7327
Practice Address - Street 1:515 ENTERPRISE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-8975
Practice Address - Country:US
Practice Address - Phone:479-717-7626
Practice Address - Fax:479-717-7327
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1107049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional