Healthcare Provider Details

I. General information

NPI: 1275284325
Provider Name (Legal Business Name): ENIOLA OGUNDE M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 DECKER DR
IRVING TX
75062-3999
US

IV. Provider business mailing address

1012 GREENWAY GLEN DR
ARLINGTON TX
76012-6541
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 817-715-4709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-194779
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73691
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: