MEDICARE: IJEOMA DIKE MS, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	63992	TX

General Provider Information

NPI Number	:	1346706041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IJEOMA DIKE MS, LPC, NCC

Provider Business Mailing Address
First Line	:	977 SHADDOCK PARK LN
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-5666
Country	:	US
Telephone Number	:	972-965-2722
Fax Number	:

Provider Business Practice Location Address
First Line	:	12959 JUPITER RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-5223
Country	:	US
Telephone Number	:	469-491-9751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2019
Last Update Date	:	02/18/2019

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