Healthcare Provider Details

I. General information

NPI: 1952073710
Provider Name (Legal Business Name): FIYINFOLUWA AYODEJI BANJO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 KOLO PL APT 201
HONOLULU HI
96826-1754
US

IV. Provider business mailing address

1108 NUECES ST UNIT 202
AUSTIN TX
78701-2199
US

V. Phone/Fax

Practice location:
  • Phone: 334-524-8668
  • Fax:
Mailing address:
  • Phone: 334-524-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number206079
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: