Provider Demographics
NPI:1619730041
Name:UNEGBU, ROBERT OGUERI (DSW, LCDC, ADC, SAP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:OGUERI
Last Name:UNEGBU
Suffix:
Gender:M
Credentials:DSW, LCDC, ADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 PERSIMMON DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707
Mailing Address - Country:US
Mailing Address - Phone:903-245-4753
Mailing Address - Fax:
Practice Address - Street 1:5811 PERSIMMON DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707
Practice Address - Country:US
Practice Address - Phone:903-245-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15288101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)