Healthcare Provider Details

I. General information

NPI: 1114379096
Provider Name (Legal Business Name): ROXANNA OLOUMI-JOHNSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 WHITE OAK DR APT 170
HOUSTON TX
77009-7567
US

IV. Provider business mailing address

1880 WHITE OAK DR APT 170
HOUSTON TX
77009-7567
US

V. Phone/Fax

Practice location:
  • Phone: 713-459-9343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number71397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: