Healthcare Provider Details

I. General information

NPI: 1760202279
Provider Name (Legal Business Name): UZOMA OWUAMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N 33RD AVE
PHOENIX AZ
85017-5202
US

IV. Provider business mailing address

1121 N 44TH ST APT 4095
PHOENIX AZ
85008-5749
US

V. Phone/Fax

Practice location:
  • Phone: 602-353-0703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-23184
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: