Provider Demographics
NPI:1639643323
Name:OKIEME, PRINCESS OMO
Entity type:Individual
Prefix:
First Name:PRINCESS
Middle Name:OMO
Last Name:OKIEME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 E 7TH ST # 338
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5003
Mailing Address - Country:US
Mailing Address - Phone:424-279-3898
Mailing Address - Fax:
Practice Address - Street 1:609 DEEP VALLEY DR # 200-057
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3629
Practice Address - Country:US
Practice Address - Phone:424-279-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW112661101YM0800X, 1041C0700X
171M00000X
CAASW80309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639643323OtherNPI
CALCSW112661OtherBBS