Provider Demographics
NPI:1902089956
Name:SHONIBARE, JOKOTADE MONSURAT (MA, LAMFT)
Entity Type:Individual
Prefix:MS
First Name:JOKOTADE
Middle Name:MONSURAT
Last Name:SHONIBARE
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6274 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5035
Mailing Address - Country:US
Mailing Address - Phone:763-572-8761
Mailing Address - Fax:
Practice Address - Street 1:4655 NICOLS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3425
Practice Address - Country:US
Practice Address - Phone:952-936-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health