Provider Demographics
NPI:1699020420
Name:TAIWO, FUNMILOLA N (LCSW, LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:FUNMILOLA
Middle Name:N
Last Name:TAIWO
Suffix:
Gender:F
Credentials:LCSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CENTURY PKWY UNIT 522
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8043
Mailing Address - Country:US
Mailing Address - Phone:440-941-5783
Mailing Address - Fax:
Practice Address - Street 1:401 CENTURY PKWY UNIT 522
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8043
Practice Address - Country:US
Practice Address - Phone:440-941-5783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1302508-SUPV1041C0700X
NCC0121401041C0700X
TX1034231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical