Provider Demographics
NPI:1609108893
Name:OGISI, OMARE (MPH)
Entity Type:Individual
Prefix:
First Name:OMARE
Middle Name:
Last Name:OGISI
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9404 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-5954
Mailing Address - Country:US
Mailing Address - Phone:918-633-2867
Mailing Address - Fax:
Practice Address - Street 1:9404 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-5954
Practice Address - Country:US
Practice Address - Phone:918-633-2867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKN/A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)