Provider Demographics
NPI:1114182615
Name:OGBEIDE, EBONY OMAKA (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:OMAKA
Last Name:OGBEIDE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:OMAKA
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 W VICTORIA ST STE F
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-5820
Mailing Address - Country:US
Mailing Address - Phone:310-669-9510
Mailing Address - Fax:
Practice Address - Street 1:901 W VICTORIA ST STE F
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-5820
Practice Address - Country:US
Practice Address - Phone:310-669-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAAMFT103023106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health