Healthcare Provider Details

I. General information

NPI: 1649534744
Provider Name (Legal Business Name): HENRY OSAYAMEN EVBUOMWAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD STE A-214
OKLAHOMA CITY OK
73106-6835
US

IV. Provider business mailing address

900 NE 122ND ST APT 2515
OKLAHOMA CITY OK
73114-8139
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6710
  • Fax: 405-601-6711
Mailing address:
  • Phone: 405-836-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5893
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: