Provider Demographics
NPI:1790016319
Name:MBONG, UKPEANWAN FRANCIS (LPC/LADC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:UKPEANWAN
Middle Name:FRANCIS
Last Name:MBONG
Suffix:
Gender:F
Credentials:LPC/LADC CANDIDATE
Other - Prefix:
Other - First Name:UKPE
Other - Middle Name:
Other - Last Name:MBONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:UKPE MBONG
Mailing Address - Street 1:508 VERREAUX DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-8182
Mailing Address - Country:US
Mailing Address - Phone:405-801-2335
Mailing Address - Fax:
Practice Address - Street 1:2220 N CLASSEN BLVD
Practice Address - Street 2:SUITE' E'
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5809
Practice Address - Country:US
Practice Address - Phone:405-528-0087
Practice Address - Fax:405-528-1802
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health