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General NPI Number Information
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NPI Number | 1013733484
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Entity Type | Organization
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Legal Business Name | KEN UGOCHUKWU-OKONKWO
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 7777 FOREST LN
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City | DALLAS
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State | TX
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Zip | 75230-2571
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Country | US
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Telephone | 972-465-9878
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Fax |
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN
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City | DALLAS
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State | TX
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Zip | 75230-2571
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Country | US
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Telephone | 972-465-9878
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Fax |
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Authorized Official
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Title or Position | COMMUNITY PSYCHOLOGIST
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Name | KEN UGOCHUKWU-OKONKWO
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Credential | CMHP
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Telephone | 945-296-9255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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