Provider Demographics
NPI:1740176205
Name:MOGOLI, KAFAYAT
Entity type:Individual
Prefix:
First Name:KAFAYAT
Middle Name:
Last Name:MOGOLI
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 1:3125 BOULDER RANCH DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1482
Mailing Address - Country:US
Mailing Address - Phone:832-517-5572
Mailing Address - Fax:
Practice Address - Street 1:3125 BOULDER RANCH DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1482
Practice Address - Country:US
Practice Address - Phone:832-517-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities