Provider Demographics
NPI:1316410590
Name:IDOWU, OLUTOBI (BCBA)
Entity Type:Individual
Prefix:
First Name:OLUTOBI
Middle Name:
Last Name:IDOWU
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TOBI
Other - Middle Name:
Other - Last Name:IDOWU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:4011 YALE SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2097
Mailing Address - Country:US
Mailing Address - Phone:832-352-8463
Mailing Address - Fax:
Practice Address - Street 1:4011 YALE SQUARE CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2097
Practice Address - Country:US
Practice Address - Phone:832-352-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2654103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst