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NPI Code Detail

MEDICARE: MARY JANE OGLESBY LMHC

MEDICARE: MARY JANE OGLESBY LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2101YM0800XMental Health CounselorMH7721FL
3101YA0400XAddiction (Substance Use Disorder) CounselorCAP 3106FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821052788
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JANE OGLESBY LMHC
Provider Business Mailing Address
First Line : PO BOX 1559
Second Line :
City : BARTOW
State : FL
Zip : 33831-1559
Country : US
Telephone Number : 863-519-0575
Fax Number : 863-582-9251
Provider Business Practice Location Address
First Line : 715 N LAKE AVE
Second Line :
City : LAKELAND
State : FL
Zip : 33801-1908
Country : US
Telephone Number : 863-413-2566
Fax Number : 863-582-9251
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2006
Last Update Date : 03/21/2013

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