Provider Demographics
NPI:1528820693
Name:UDOZORH, KOSISOCHI WILLIAM (LMFT-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:KOSISOCHI
Middle Name:WILLIAM
Last Name:UDOZORH
Suffix:
Gender:M
Credentials:LMFT-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3583
Mailing Address - Country:US
Mailing Address - Phone:469-412-3893
Mailing Address - Fax:
Practice Address - Street 1:8340 MOJAVE TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-3638
Practice Address - Country:US
Practice Address - Phone:817-771-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional