Healthcare Provider Details

I. General information

NPI: 1417860081
Provider Name (Legal Business Name): MICHAEL ODINAKA UGBOR PHD, MHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 THROOP AVE
BROOKLYN NY
11216-2433
US

IV. Provider business mailing address

583 THROOP AVE
BROOKLYN NY
11216-2433
US

V. Phone/Fax

Practice location:
  • Phone: 254-229-4266
  • Fax:
Mailing address:
  • Phone: 254-229-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00997600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10039
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP139763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: