Healthcare Provider Details

I. General information

NPI: 1861101206
Provider Name (Legal Business Name): UCHE OKOLIE COUNSELING LICENSED CLINICAL SOCIAL WORKER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WILSHIRE BLVD
LOS ANGELES CA
90017-2415
US

IV. Provider business mailing address

1001 WILSHIRE BOULEVARD PMB PMB 2056
LOS ANGELES CA
90017
US

V. Phone/Fax

Practice location:
  • Phone: 818-724-8077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: UCHE OKOLIE
Title or Position: CEO
Credential: LCSW
Phone: 831-776-8886