Provider Demographics
NPI:1508594888
Name:IKPO, FYNEFACE UCHE (PHD)
Entity Type:Individual
Prefix:DR
First Name:FYNEFACE
Middle Name:UCHE
Last Name:IKPO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:FYNE
Other - Middle Name:UCHE
Other - Last Name:IKPO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1618 KINGSPOINT DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5045
Mailing Address - Country:US
Mailing Address - Phone:214-597-5946
Mailing Address - Fax:
Practice Address - Street 1:2556 LILLIAN MILLER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7207
Practice Address - Country:US
Practice Address - Phone:469-943-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist