Provider Demographics
NPI:1740778927
Name:OGLESBY, KELSEY (LCPC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 600TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PULASKI
Mailing Address - State:IL
Mailing Address - Zip Code:62548-6009
Mailing Address - Country:US
Mailing Address - Phone:217-671-2377
Mailing Address - Fax:
Practice Address - Street 1:1807 600TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT PULASKI
Practice Address - State:IL
Practice Address - Zip Code:62548-6009
Practice Address - Country:US
Practice Address - Phone:217-671-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180012997OtherCLINICAL LICENSE