Provider Demographics
NPI:1942822952
Name:OAK LEAF BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:OAK LEAF BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODINIGWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:832-630-1354
Mailing Address - Street 1:1600 ELDRIDGE PKWY APT 3607
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 ELDRIDGE PKWY APT 3607
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1667
Practice Address - Country:US
Practice Address - Phone:832-630-1354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health