Provider Demographics
NPI:1962606624
Name:OGLE, FREDA
Entity type:Individual
Prefix:
First Name:FREDA
Middle Name:
Last Name:OGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:24885 BUCK CREEK ROAD
Mailing Address - City:PANAMA
Mailing Address - State:OK
Mailing Address - Zip Code:74951-0802
Mailing Address - Country:US
Mailing Address - Phone:918-839-3235
Mailing Address - Fax:
Practice Address - Street 1:24885 BUCK CREEK RD
Practice Address - Street 2:
Practice Address - City:PANAMA
Practice Address - State:OK
Practice Address - Zip Code:74951-0802
Practice Address - Country:US
Practice Address - Phone:918-963-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health