Provider Demographics
NPI:1811481039
Name:OGDEN, GILBERT L (LEP)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:L
Last Name:OGDEN
Suffix:
Gender:M
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 E CANAL DR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4161
Mailing Address - Country:US
Mailing Address - Phone:209-667-0887
Mailing Address - Fax:
Practice Address - Street 1:1574 E CANAL DR
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4161
Practice Address - Country:US
Practice Address - Phone:209-667-0887
Practice Address - Fax:209-667-6441
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP2462103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool