Healthcare Provider Details

I. General information

NPI: 1679295646
Provider Name (Legal Business Name): KOFI AMOATENG ADJEPONG PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17820 MOUND RD STE B
CYPRESS TX
77433-4903
US

IV. Provider business mailing address

17820 MOUND RD STE B
CYPRESS TX
77433-4903
US

V. Phone/Fax

Practice location:
  • Phone: 281-612-8580
  • Fax: 916-287-4068
Mailing address:
  • Phone: 281-612-8580
  • Fax: 916-287-4068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number41397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: