Healthcare Provider Details

I. General information

NPI: 1982446381
Provider Name (Legal Business Name): OGECHI UJU-EKE LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 S ANTHONY BLVD
FORT WAYNE IN
46803-3609
US

IV. Provider business mailing address

1010 STEEPLECHASE CT APT 1D
FORT WAYNE IN
46804-2329
US

V. Phone/Fax

Practice location:
  • Phone: 260-255-3514
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99125294A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: