Provider Demographics
NPI:1710291547
Name:OBATUSIN, OLUFUNKE OMOWUNMI (PLMHP)
Entity Type:Individual
Prefix:MRS
First Name:OLUFUNKE
Middle Name:OMOWUNMI
Last Name:OBATUSIN
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:MRS
Other - First Name:OLA
Other - Middle Name:OMOWUNMI
Other - Last Name:OBATUSIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:607 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3411
Mailing Address - Country:US
Mailing Address - Phone:404-729-7796
Mailing Address - Fax:402-371-9643
Practice Address - Street 1:200 N 34TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3197
Practice Address - Country:US
Practice Address - Phone:402-371-3044
Practice Address - Fax:402-371-9643
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health