Healthcare Provider Details

I. General information

NPI: 1992456313
Provider Name (Legal Business Name): DIANA OBULANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 BELMONT ST
HOUSTON TX
77005-3402
US

IV. Provider business mailing address

6350 BELMONT ST
HOUSTON TX
77005-3402
US

V. Phone/Fax

Practice location:
  • Phone: 713-894-2940
  • Fax:
Mailing address:
  • Phone: 713-894-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number81251
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: