MEDICARE: PRINCESS OMO OKIEME

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	LCSW112661	CA
2	1041C0700X	Clinical Social Worker	LCSW112661	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1639643323	OTHER	CA	NPI
2	LCSW112661	OTHER	CA	BBS

General Provider Information

NPI Number	:	1639643323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCESS OMO OKIEME

Provider Business Mailing Address
First Line	:	3350 E 7TH ST # 338
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-5003
Country	:	US
Telephone Number	:	424-279-3898
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 DEEP VALLEY DR # 200-057
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3629
Country	:	US
Telephone Number	:	424-279-3898
Fax Number	:

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

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	04/19/2024

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Directions to “ PRINCESS OMO OKIEME ” Practice Location

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