Provider Demographics
NPI:1720282320
Name:OGDEN, GREG D (LMFT)
Entity type:Individual
Prefix:MR
First Name:GREG
Middle Name:D
Last Name:OGDEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:DEAN
Other - Last Name:OGDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2225 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1555
Mailing Address - Country:US
Mailing Address - Phone:918-308-5515
Mailing Address - Fax:
Practice Address - Street 1:2225 N UNION ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1555
Practice Address - Country:US
Practice Address - Phone:918-308-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS297101YA0400X
ID106H00000X
KS0357106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100229210AMedicaid