Provider Demographics
NPI:1639329477
Name:OGLE, MARY KATHLEEN (LCSW, LIMHP, MHP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:OGLE
Suffix:
Gender:F
Credentials:LCSW, LIMHP, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 BROADMOORE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2317
Mailing Address - Country:US
Mailing Address - Phone:402-486-4754
Mailing Address - Fax:
Practice Address - Street 1:1911 BROADMOORE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2317
Practice Address - Country:US
Practice Address - Phone:402-486-4754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE226101YM0800X
NE1553101YM0800X
NE8411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical