1043063019 NPI number — MS. CHIGOZIE EDNAH OBICHUKU LPC

Table of content: MS. CHIGOZIE EDNAH OBICHUKU LPC (NPI 1043063019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043063019 NPI number — MS. CHIGOZIE EDNAH OBICHUKU LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBICHUKU
Provider First Name:
CHIGOZIE
Provider Middle Name:
EDNAH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OBI
Provider Other First Name:
CHI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043063019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12325 SHADOW CREEK PKWY APT 113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584-7373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-339-2498
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11100 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77031-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
346-219-0434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  86943 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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