Healthcare Provider Details

I. General information

NPI: 1144342494
Provider Name (Legal Business Name): BRADLEY OGILVIE M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 W ST NW
WASHINGTON DC
20009-7509
US

IV. Provider business mailing address

1222 W ST NW
WASHINGTON DC
20009-7509
US

V. Phone/Fax

Practice location:
  • Phone: 301-257-5348
  • Fax:
Mailing address:
  • Phone: 301-257-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT000062
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: