Provider Demographics
NPI:1558085191
Name:COKER, OLAMIDE R (MS)
Entity Type:Individual
Prefix:
First Name:OLAMIDE
Middle Name:R
Last Name:COKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17017 FLAGSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-2041
Mailing Address - Country:US
Mailing Address - Phone:651-815-1930
Mailing Address - Fax:
Practice Address - Street 1:17017 FLAGSTONE DR
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-2041
Practice Address - Country:US
Practice Address - Phone:651-815-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional