Healthcare Provider Details

I. General information

NPI: 1285590497
Provider Name (Legal Business Name): MRS. ATINUKE COMFORT OKUNADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4577 W PECOS RD
LAVEEN AZ
85339-9002
US

IV. Provider business mailing address

9431 W SHERIDAN ST
PHOENIX AZ
85037-4435
US

V. Phone/Fax

Practice location:
  • Phone: 520-550-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW21019
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-21019
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: