Provider Demographics
NPI:1083144521
Name:OBASEKI, TYRONE (LPC)
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:OBASEKI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55040
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23471-5040
Mailing Address - Country:US
Mailing Address - Phone:757-288-6365
Mailing Address - Fax:
Practice Address - Street 1:1631 E 2ND ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4490
Practice Address - Country:US
Practice Address - Phone:757-288-6365
Practice Address - Fax:757-767-4025
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional