Healthcare Provider Details

I. General information

NPI: 1669892063
Provider Name (Legal Business Name): FEMI BENJAMIN FAFUNMI MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 S WESTERN AVE STE 300
OKLAHOMA CITY OK
73139
US

IV. Provider business mailing address

9105 STACY LYNN LN
YUKON OK
73099-8485
US

V. Phone/Fax

Practice location:
  • Phone: 347-579-8416
  • Fax: 405-584-4070
Mailing address:
  • Phone: 347-579-8416
  • Fax: 405-584-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7211
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: