Healthcare Provider Details

I. General information

NPI: 1437817921
Provider Name (Legal Business Name): JULIE OGLESBY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MAIN ST
VAN BUREN AR
72956-4731
US

IV. Provider business mailing address

161 BETHESDA RIDGE LN
MENA AR
71953-4703
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-3200
  • Fax:
Mailing address:
  • Phone: 501-538-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JULIE OGLESBY
Title or Position: MENTAL HEALTH PROFESSIONAL
Credential: LPC, LMFT
Phone: 501-538-7670