Provider Demographics
NPI:1487839726
Name:IJEOMA ODUMODU
Entity Type:Organization
Organization Name:IJEOMA ODUMODU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUMODU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-231-8547
Mailing Address - Street 1:3411 WALNUT BEND LN
Mailing Address - Street 2:APT 236
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4805
Mailing Address - Country:US
Mailing Address - Phone:832-231-8547
Mailing Address - Fax:
Practice Address - Street 1:3411 WALNUT BEND LN
Practice Address - Street 2:APT 236
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4805
Practice Address - Country:US
Practice Address - Phone:832-231-8547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health