Provider Demographics
NPI:1205015104
Name:IGWILO, CHRIS OKWUCHUKWU
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:OKWUCHUKWU
Last Name:IGWILO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:IGWILO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:6722 WALNUT SQ
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7550
Mailing Address - Country:US
Mailing Address - Phone:713-516-6662
Mailing Address - Fax:281-491-0472
Practice Address - Street 1:6722 WALNUT SQ
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-7550
Practice Address - Country:US
Practice Address - Phone:713-516-6662
Practice Address - Fax:281-491-0472
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18951101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional