Provider Demographics
NPI:1679169254
Name:OKOGWU, DONNA LAVERN
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LAVERN
Last Name:OKOGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 MISSION TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5264
Mailing Address - Country:US
Mailing Address - Phone:713-505-3319
Mailing Address - Fax:
Practice Address - Street 1:8610 MISSION TERRACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5264
Practice Address - Country:US
Practice Address - Phone:713-505-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81470101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional