Healthcare Provider Details

I. General information

NPI: 1922591627
Provider Name (Legal Business Name): CHRISTIANAH ATINUKE GBADEOYELAKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LOUIS HENNA BLVD APT 8102
ROUND ROCK TX
78664-7562
US

IV. Provider business mailing address

650 LOUIS HENNA BLVD APT 8102
ROUND ROCK TX
78664-7562
US

V. Phone/Fax

Practice location:
  • Phone: 210-744-4315
  • Fax:
Mailing address:
  • Phone: 210-744-4315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateTX
# 9
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: