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NPI Code Detail

MEDICARE: MRS. OMOLADUN TIAMIYU M.A

MEDICARE: MRS. OMOLADUN TIAMIYU M.A
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
1101YM0800XMental Health CounselorMO

General Provider Information

NPI Number : 1851416697
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. OMOLADUN TIAMIYU M.A
Provider Business Mailing Address
First Line : 6739 PAGE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63133-1635
Country : US
Telephone Number : 314-862-4419
Fax Number :
Provider Business Practice Location Address
First Line : 6739 PAGE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63133-1635
Country : US
Telephone Number : 314-862-4419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 07/08/2007

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