Healthcare Provider Details

I. General information

NPI: 1093267684
Provider Name (Legal Business Name): MR. OBIOHA CHUKWUMA NWABUGWU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2016
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 GLOVER RIVER DR
YUKON OK
73099-7838
US

IV. Provider business mailing address

9800 GLOVER RIVER DR
YUKON OK
73099-7838
US

V. Phone/Fax

Practice location:
  • Phone: 214-254-0240
  • Fax:
Mailing address:
  • Phone: 214-254-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number85594
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC6020
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC07084
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: