Provider Demographics
NPI:1538214853
Name:DENNIS, OLLIE CHARLES (M A, ED D)
Entity type:Individual
Prefix:DR
First Name:OLLIE
Middle Name:CHARLES
Last Name:DENNIS
Suffix:
Gender:M
Credentials:M A, ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 GLENVIEW DR
Mailing Address - Street 2:SUITE-C
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3424
Mailing Address - Country:US
Mailing Address - Phone:270-651-2816
Mailing Address - Fax:270-651-2816
Practice Address - Street 1:1010 GLENVIEW DR
Practice Address - Street 2:SUITE-C
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3424
Practice Address - Country:US
Practice Address - Phone:270-651-2816
Practice Address - Fax:270-651-2816
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-100103TC0700X
KY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89001002Medicaid
KY3008901Medicare ID - Type Unspecified