Provider Demographics
NPI:1689941809
Name:BAJULAIYE, ADE A
Entity Type:Individual
Prefix:
First Name:ADE
Middle Name:A
Last Name:BAJULAIYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8122 N.W. 78TH TER
Mailing Address - Street 2:OKC
Mailing Address - City:OKLAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:73132
Mailing Address - Country:US
Mailing Address - Phone:405-720-9752
Mailing Address - Fax:
Practice Address - Street 1:8122 N.W. 78TH TER
Practice Address - Street 2:OKC
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73132
Practice Address - Country:US
Practice Address - Phone:405-720-9752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TR0400X103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation