Healthcare Provider Details

I. General information

NPI: 1346808854
Provider Name (Legal Business Name): EUNICE OGBUJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2025
Certification Date:
Deactivation Date: 03/27/2025
Reactivation Date: 05/30/2025

III. Provider practice location address

10502 FOUNTAIN LAKE DR APT 422
STAFFORD TX
77477-3716
US

IV. Provider business mailing address

10502 FOUNTAIN LAKE DR APT 422
STAFFORD TX
77477-3716
US

V. Phone/Fax

Practice location:
  • Phone: 832-532-7173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: