MEDICARE: WAABEKE CHARLOTTE NWIKPO

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VAL924876979	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396233698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAABEKE CHARLOTTE NWIKPO

Provider Business Mailing Address
First Line	:	9901 RICHMOND AVE APT 320
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-4513
Country	:	US
Telephone Number	:	832-425-5627
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 RICHMOND AVE APT 320
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-4513
Country	:	US
Telephone Number	:	832-425-5627
Fax Number	:

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

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	11/15/2021

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Directions to “ WAABEKE CHARLOTTE NWIKPO ” Practice Location

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