Healthcare Provider Details

I. General information

NPI: 1265703862
Provider Name (Legal Business Name): LETTY OWUOR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 NW LAKE WHITNEY PL SUITE. 102 &103
PORT SAINT LUCIE FL
34986-1605
US

IV. Provider business mailing address

151 SW PALM DR APT 304
PORT SAINT LUCIE FL
34986-1795
US

V. Phone/Fax

Practice location:
  • Phone: 772-337-8164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: