Healthcare Provider Details

I. General information

NPI: 1649936543
Provider Name (Legal Business Name): TOLULOPE MEJOLAGBE LMHC-ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 11/15/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 DENNIS ST
HOUSTON TX
77004
US

IV. Provider business mailing address

3343 DENNIS ST
HOUSTON TX
77004
US

V. Phone/Fax

Practice location:
  • Phone: 281-716-7638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61203956
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: