Healthcare Provider Details

I. General information

NPI: 1285966069
Provider Name (Legal Business Name): IKE ALPHONSUS OKWUONU LPC CANDIDATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: IMELDA CHINELO OKWUONU LPN

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16500 SUNNY HOLLOW RD
EDMOND OK
73012-6743
US

IV. Provider business mailing address

16500 SUNNY HOLLOW RD
EDMOND OK
73012-6743
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-7804
  • Fax:
Mailing address:
  • Phone: 405-341-7804
  • 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: