Provider Demographics
NPI:1174136774
Name:OGLETREE, MELENA
Entity type:Individual
Prefix:
First Name:MELENA
Middle Name:
Last Name:OGLETREE
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 1:8011 PHILIPS HWY STE 10
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7459
Mailing Address - Country:US
Mailing Address - Phone:904-928-0112
Mailing Address - Fax:
Practice Address - Street 1:8011 PHILIPS HWY STE 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7459
Practice Address - Country:US
Practice Address - Phone:904-928-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician