Provider Demographics
NPI:1467015784
Name:AGADA, GLORY EDOMAOBI
Entity Type:Individual
Prefix:
First Name:GLORY
Middle Name:EDOMAOBI
Last Name:AGADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7918 HUDDERSFIELD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-6161
Mailing Address - Country:US
Mailing Address - Phone:832-398-5600
Mailing Address - Fax:
Practice Address - Street 1:12340 JONES RD STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3129
Practice Address - Country:US
Practice Address - Phone:281-894-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77363101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional