Healthcare Provider Details

I. General information

NPI: 1609248236
Provider Name (Legal Business Name): JULIANN DANIELL OGLESBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE OGLESBY

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 HEALTH PARK DR
MENA AR
71953
US

IV. Provider business mailing address

PO BOX 1848
MENA AR
71953-1841
US

V. Phone/Fax

Practice location:
  • Phone: 479-437-3449
  • Fax: 479-437-3454
Mailing address:
  • Phone: 479-437-3779
  • Fax: 479-437-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM1807014
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1807091
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: