Provider Demographics
NPI:1144540055
Name:EVBUOMWAN, HENRIETTA NGOZI (MSC, LPC)
Entity type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:NGOZI
Last Name:EVBUOMWAN
Suffix:
Gender:F
Credentials:MSC, LPC
Other - Prefix:
Other - First Name:HENRIETTA
Other - Middle Name:NGOZI
Other - Last Name:EVBUOMWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSC LPC
Mailing Address - Street 1:1330 N CLASSEN BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6835
Mailing Address - Country:US
Mailing Address - Phone:405-821-8646
Mailing Address - Fax:
Practice Address - Street 1:1330 N CLASSEN BLVD STE 215
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6834
Practice Address - Country:US
Practice Address - Phone:405-821-8646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)