Provider Demographics
NPI:1609248236
Name:OGLESBY, JULIANN DANIELL
Entity Type:Individual
Prefix:
First Name:JULIANN
Middle Name:DANIELL
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:OGLESBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-1841
Mailing Address - Country:US
Mailing Address - Phone:479-437-3779
Mailing Address - Fax:479-437-3454
Practice Address - Street 1:136 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953
Practice Address - Country:US
Practice Address - Phone:479-437-3449
Practice Address - Fax:479-437-3454
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM1807014106H00000X
ARP1807091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP1807091OtherLICENSE