Healthcare Provider Details

I. General information

NPI: 1982202594
Provider Name (Legal Business Name): OLUGUS FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44077 W. PALMEN DR.
MARICOPA AZ
85138
US

IV. Provider business mailing address

44077 W. PALMEN DR.
MARICOPA AZ
85138
US

V. Phone/Fax

Practice location:
  • Phone: 405-474-3054
  • Fax:
Mailing address:
  • Phone: 405-474-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KEAUNA D. OLUGU
Title or Position: CLINICAL
Credential: D.O
Phone: 405-474-3054