Provider Demographics
NPI:1083961122
Name:OMEWAH, IBIFUBARA DAYEBA (EDD, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:IBIFUBARA
Middle Name:DAYEBA
Last Name:OMEWAH
Suffix:
Gender:F
Credentials:EDD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 ELKHART DR
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-1943
Mailing Address - Country:US
Mailing Address - Phone:214-476-3603
Mailing Address - Fax:
Practice Address - Street 1:1301 NORTHWEST HWY STE 203
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5896
Practice Address - Country:US
Practice Address - Phone:469-814-0589
Practice Address - Fax:972-499-1244
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX65641OtherLICENSED PROFESSIONAL COUNSELOR INTERN