Provider Demographics
NPI:1659966737
Name:OGLETREE, MATTHEW (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:OGLETREE
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 GLENDALE DR APT 5
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1535
Mailing Address - Country:US
Mailing Address - Phone:513-345-0195
Mailing Address - Fax:
Practice Address - Street 1:155 TRI COUNTY PKWY STE 237
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3238
Practice Address - Country:US
Practice Address - Phone:513-345-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
OH181032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0498289Medicaid