Healthcare Provider Details

I. General information

NPI: 1972268407
Provider Name (Legal Business Name): MRS. STELLA EGUMA OGBONNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2021
Last Update Date: 10/31/2021
Certification Date: 10/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 CORPORATE DR STE 111
STAFFORD TX
77477-4018
US

IV. Provider business mailing address

7615 BLOSSOMMIST LN
RICHMOND TX
77407-2788
US

V. Phone/Fax

Practice location:
  • Phone: 832-343-2755
  • Fax:
Mailing address:
  • Phone: 832-343-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number83302
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: