Healthcare Provider Details

I. General information

NPI: 1326448655
Provider Name (Legal Business Name): UWEM UKPONG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 GULFTON ST STE 100
HOUSTON TX
77081-1107
US

IV. Provider business mailing address

3007 CAROLINE ST
HOUSTON TX
77004-2822
US

V. Phone/Fax

Practice location:
  • Phone: 713-457-4372
  • Fax: 713-457-0945
Mailing address:
  • Phone: 713-528-2328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number71208
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: