Healthcare Provider Details

I. General information

NPI: 1679169254
Provider Name (Legal Business Name): DONNA LAVERN OKOGWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8610 MISSION TERRACE DR
HOUSTON TX
77083-5264
US

IV. Provider business mailing address

8610 MISSION TERRACE DR
HOUSTON TX
77083-5264
US

V. Phone/Fax

Practice location:
  • Phone: 713-505-3319
  • Fax:
Mailing address:
  • Phone: 713-505-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number81470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: