Doctor Name: | MR. KYLE R OGLE |
NPI Number: | 1154567618 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCPC |
License Number: | LC2912 |
Business Practice Address: | 4305 Travancore Rd Randallstown, MD - 211331315 |
Business Phone Number: | 4105211077 |
Business Fax Number: | 4195211077 |
Mailing Address: | 4305 Travancore Rd, RANDALLSTOWN |
State: | MD |
Postal Code: | 211331315 |
Phone Number: | 4105211077 |
Fax Number: | 4195211077 |
NPI Enumeration Date: | 01/05/2009 |
NPI Last Update Date: | 01/05/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LC2912 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |