Healthcare Provider Details

I. General information

NPI: 1538433685
Provider Name (Legal Business Name): OSAIYEKEMWEN EVELYN OKUNBOR MS, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 MADISON AVE
MEMPHIS TN
38104-2327
US

IV. Provider business mailing address

1435 MADISON AVE 7
MEMPHIS TN
38104-6317
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-4213
  • Fax: 901-726-4281
Mailing address:
  • Phone: 901-337-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: