Healthcare Provider Details

I. General information

NPI: 1538214853
Provider Name (Legal Business Name): OLLIE CHARLES DENNIS M. A., ED. D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 GLENVIEW DR SUITE-C
GLASGOW KY
42141-3424
US

IV. Provider business mailing address

1010 GLENVIEW DR SUITE-C
GLASGOW KY
42141-3424
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-2816
  • Fax: 270-651-2816
Mailing address:
  • Phone: 270-651-2816
  • Fax: 270-651-2816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberKY-100
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: