Provider Demographics
NPI:1770818973
Name:OSO, KOFOWOROLA DEON
Entity Type:Individual
Prefix:
First Name:KOFOWOROLA
Middle Name:DEON
Last Name:OSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KOFOWOROLA
Other - Middle Name:DEON
Other - Last Name:OSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:5064 SUBLIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4059
Mailing Address - Country:US
Mailing Address - Phone:702-646-3458
Mailing Address - Fax:
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:702-791-9359
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty