Healthcare Provider Details

I. General information

NPI: 1073064358
Provider Name (Legal Business Name): JOHN KAYODE OJEWOLE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WILLOW PASS RD SUITE 200
CONCORD CA
94520-5823
US

IV. Provider business mailing address

10 DOUGLAS DR STE 140
MARTINEZ CA
94553-4078
US

V. Phone/Fax

Practice location:
  • Phone: 925-646-5480
  • Fax: 925-646-5622
Mailing address:
  • Phone: 925-313-1155
  • Fax: 925-313-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF 90816
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: