MEDICARE: CONSTANCE SILI AKONUMBO STUDENT COUNSELOR

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	LPC07485	OK

General Provider Information

NPI Number	:	1760937221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE SILI AKONUMBO STUDENT COUNSELOR

Provider Business Mailing Address
First Line	:	2614 N MERIDIAN AVE
Second Line	:	APT. 215
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1001
Country	:	US
Telephone Number	:	405-408-1244
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 N MERIDIAN AVE
Second Line	:	APT. 215
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1001
Country	:	US
Telephone Number	:	405-408-1244
Fax Number	:

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

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/05/2024

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