Provider Demographics
NPI:1265832331
Name:UDO-EMA, INYANG
Entity Type:Individual
Prefix:
First Name:INYANG
Middle Name:
Last Name:UDO-EMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-685-6120
Mailing Address - Fax:602-265-6973
Practice Address - Street 1:1455 S STAPLEY DR
Practice Address - Street 2:#13
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5849
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-685-6078
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-13859101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor