=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194256578
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICK OGLETREE MA MFT LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2017
-----------------------------------------------------
Last Update Date | 03/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4660 NE BELKNAP CT SUITE 101-S
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97124-6467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-705-0990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4660 NE BELKNAP CT SUITE 101-S
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97124-6467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-705-0990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | C3698
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------