MEDICARE: ELEXUS OGLESBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	82951	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	82951	TX
3	101YM0800X	Mental Health Counselor	82951	TX
4	101YP2500X	Professional Counselor	82951	TX

General Provider Information

NPI Number	:	1659033793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEXUS OGLESBY

Provider Business Mailing Address
First Line	:	4120 N COLLINS ST STE 200
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76005-4554
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 N COLLINS ST STE 200
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76005-4554
Country	:	US
Telephone Number	:	817-330-4079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	10/06/2021

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Directions to “ ELEXUS OGLESBY ” Practice Location

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