Healthcare Provider Details

I. General information

NPI: 1124705314
Provider Name (Legal Business Name): CHIDIMMA ULOMA OKORO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14511 FALLING CREEK DR STE 203
HOUSTON TX
77014-1280
US

IV. Provider business mailing address

7526 HIGHLAND CHASE DR
RICHMOND TX
77407-2451
US

V. Phone/Fax

Practice location:
  • Phone: 281-204-5375
  • Fax:
Mailing address:
  • Phone: 281-204-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: