Provider Demographics
NPI:1154633105
Name:SOMADE, IBIRONKE AGBEKE (THERAPIST)
Entity Type:Individual
Prefix:
First Name:IBIRONKE
Middle Name:AGBEKE
Last Name:SOMADE
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-4515
Mailing Address - Country:US
Mailing Address - Phone:405-601-1154
Mailing Address - Fax:405-601-1183
Practice Address - Street 1:5714 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4515
Practice Address - Country:US
Practice Address - Phone:405-601-1154
Practice Address - Fax:405-601-1183
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor