MEDICARE: OSAIYEKEMWEN EVELYN OKUNBOR MS, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1538433685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSAIYEKEMWEN EVELYN OKUNBOR MS, NCC

Provider Business Mailing Address
First Line	:	1435 MADISON AVE
Second Line	:	7
City	:	MEMPHIS
State	:	TN
Zip	:	38104-6317
Country	:	US
Telephone Number	:	901-337-4626
Fax Number	:

Provider Business Practice Location Address
First Line	:	1384 MADISON AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2327
Country	:	US
Telephone Number	:	901-726-4213
Fax Number	:	901-726-4281

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

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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