Healthcare Provider Details

I. General information

NPI: 1649925181
Provider Name (Legal Business Name): OKINA YUME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 GEODE LN
JARRELL TX
76537-1466
US

IV. Provider business mailing address

249 GEODE LN
JARRELL TX
76537-1466
US

V. Phone/Fax

Practice location:
  • Phone: 512-202-9008
  • Fax:
Mailing address:
  • Phone: 512-202-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANNE-MARIE TAGUE WHITE
Title or Position: OWNER
Credential: LPC
Phone: 512-202-9008