Healthcare Provider Details

I. General information

NPI: 1063303022
Provider Name (Legal Business Name): KOJO MINTAH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KOJO MINTAH

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NORFOLK ST STE 455
HOUSTON TX
77098-4119
US

IV. Provider business mailing address

2914 LA FONTAINE DRIVE
HOUSTON TX
77014-2492
US

V. Phone/Fax

Practice location:
  • Phone: 832-278-1849
  • Fax: 713-513-5194
Mailing address:
  • Phone: 281-850-4453
  • Fax: 713-513-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number40203
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number40203
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number40203
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number40203
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number40203
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number40203
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: