Provider Demographics
NPI:1467015164
Name:ROJUGBOKAN, IBUKUNOLA BUKKY (LSSP)
Entity Type:Individual
Prefix:
First Name:IBUKUNOLA
Middle Name:BUKKY
Last Name:ROJUGBOKAN
Suffix:
Gender:F
Credentials:LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 E AUDEN CIR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3284
Mailing Address - Country:US
Mailing Address - Phone:281-467-1784
Mailing Address - Fax:281-778-9101
Practice Address - Street 1:3910 E AUDEN CIR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3284
Practice Address - Country:US
Practice Address - Phone:281-467-1784
Practice Address - Fax:281-778-9101
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59940101YM0800X
TX32769103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14256433OtherDRIVER LICENSE NUMBER