Healthcare Provider Details

I. General information

NPI: 1518968981
Provider Name (Legal Business Name): GAYLE THERESE OGDEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GAYLE TERRI RAUEN LMHC LCAC

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/26/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 PINE LAKE DR.
GREENWOOD IN
46143-7515
US

IV. Provider business mailing address

832 PINE LAKE DR.
GREENWOOD IN
46143-7515
US

V. Phone/Fax

Practice location:
  • Phone: 317-494-0512
  • Fax: 317-530-5469
Mailing address:
  • Phone: 317-494-0512
  • Fax: 317-530-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39001392A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: