Provider Demographics
NPI:1881842565
Name:PATE OGLESBY, LATRICE TONIAS (LCPC)
Entity Type:Individual
Prefix:
First Name:LATRICE
Middle Name:TONIAS
Last Name:PATE 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 1:2325 177TH STREET
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60411
Mailing Address - Country:US
Mailing Address - Phone:708-895-7310
Mailing Address - Fax:708-895-6490
Practice Address - Street 1:2325 177TH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1722
Practice Address - Country:US
Practice Address - Phone:708-895-7310
Practice Address - Fax:708-895-6490
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.003638101Y00000X
IL180.007113101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.007113OtherLCPC LICENSE NUMBER