Healthcare Provider Details

I. General information

NPI: 1891107579
Provider Name (Legal Business Name): CHIEMEZIE IBEKWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 NW 39TH ST. STE. #103
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

2401 NW 39TH ST. STE. #103
OKLAHOMA CITY OK
73112
US

V. Phone/Fax

Practice location:
  • Phone: 678-629-2572
  • Fax: 405-606-7893
Mailing address:
  • Phone: 678-629-2572
  • Fax: 405-606-7893

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: