Healthcare Provider Details

I. General information

NPI: 1154194660
Provider Name (Legal Business Name): JULIET O OGBONNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 SAWDUST RD STE 260
THE WOODLANDS TX
77380-2986
US

IV. Provider business mailing address

3407 LA SEINE LN
SPRING TX
77388-4135
US

V. Phone/Fax

Practice location:
  • Phone: 832-303-8933
  • Fax: 832-383-3817
Mailing address:
  • Phone: 281-790-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: