Provider Demographics
NPI:1770383374
Name:OGANLA, DARE M
Entity type:Individual
Prefix:
First Name:DARE
Middle Name:M
Last Name:OGANLA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6839
Mailing Address - Country:US
Mailing Address - Phone:918-682-9292
Mailing Address - Fax:918-682-0054
Practice Address - Street 1:814 W OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6839
Practice Address - Country:US
Practice Address - Phone:918-682-9292
Practice Address - Fax:918-682-0054
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTEMP101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor