Provider Demographics
NPI:1174128441
Name:OGLESBY, WILLIAM RUSSELL II
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:OGLESBY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3878 MCNAMER BROWN RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-9086
Mailing Address - Country:US
Mailing Address - Phone:740-370-8424
Mailing Address - Fax:
Practice Address - Street 1:3878 MCNAMER BROWN RD
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-9086
Practice Address - Country:US
Practice Address - Phone:740-370-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor