Healthcare Provider Details

I. General information

NPI: 1013830041
Provider Name (Legal Business Name): AUGUSTINE OKOLI LPC, LCPC, CRAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AUSTIN OKOLI LPC, LCPC, CRAADC

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 19TH TER
KANSAS CITY MO
64108-2026
US

IV. Provider business mailing address

12124 E 54TH ST
KANSAS CITY MO
64133-3009
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-5709
  • Fax: 816-404-6272
Mailing address:
  • Phone: 816-404-5709
  • Fax: 816-404-6272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2310
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number04381
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001002659
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: