Provider Demographics
NPI:1134639982
Name:OBI, BLESSING CHIAWUOTU
Entity Type:Individual
Prefix:MS
First Name:BLESSING
Middle Name:CHIAWUOTU
Last Name:OBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S RANCHO DR # 4-918
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3837
Mailing Address - Country:US
Mailing Address - Phone:702-820-6186
Mailing Address - Fax:702-608-7752
Practice Address - Street 1:3216 W CHARLESTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1983
Practice Address - Country:US
Practice Address - Phone:702-820-6186
Practice Address - Fax:702-608-7752
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1134639982Medicaid