Individual
MARK R OFENLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
1273 DAYTON MOUNTAIN HWY, DAYTON, TN 37321-2816
(423) 570-1900
(423) 570-0008
Mailing address
PO BOX 307, DAYTON, TN 37321-0307
(423) 570-1900
(423) 570-0008
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000001005
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3685725
—
TN
01
—
4024807
BLUE CROSS/BLUE SHIELD
TN
Enumeration date
10/05/2006
Last updated
07/08/2007
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