Provider Demographics
NPI:1740485051
Name:OGLETREE, ANDREA LADONNA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LADONNA
Last Name:OGLETREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12403 SILVERWYCK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2852
Mailing Address - Country:US
Mailing Address - Phone:713-692-4566
Mailing Address - Fax:713-697-7979
Practice Address - Street 1:12403 SILVERWYCK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2852
Practice Address - Country:US
Practice Address - Phone:713-692-4566
Practice Address - Fax:713-697-7979
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities