Provider Demographics
NPI:1639551724
Name:OJEDA, LIZETTE
Entity Type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name:OJEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZETTE
Other - Middle Name:OJEDA
Other - Last Name:OMPENDOGUELET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 E FERNHURST DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1431
Mailing Address - Country:US
Mailing Address - Phone:979-820-7024
Mailing Address - Fax:
Practice Address - Street 1:535 E FERNHURST DR
Practice Address - Street 2:SUITE 107
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1431
Practice Address - Country:US
Practice Address - Phone:281-786-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36264103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist