Provider Demographics
NPI:1700498565
Name:OKORONKWO, KELECHI PIUS
Entity type:Individual
Prefix:
First Name:KELECHI
Middle Name:PIUS
Last Name:OKORONKWO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 CORDES DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1386
Mailing Address - Country:US
Mailing Address - Phone:281-908-0642
Mailing Address - Fax:281-715-5886
Practice Address - Street 1:2515 CORDES DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1386
Practice Address - Country:US
Practice Address - Phone:281-908-0642
Practice Address - Fax:281-715-5886
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician