Provider Demographics
NPI:1134861214
Name:ONUMA, KEITA (MA, THM, MT-BC, LPC)
Entity type:Individual
Prefix:
First Name:KEITA
Middle Name:
Last Name:ONUMA
Suffix:
Gender:M
Credentials:MA, THM, MT-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5338 KIAMESHA WAY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1008
Mailing Address - Country:US
Mailing Address - Phone:480-510-3117
Mailing Address - Fax:
Practice Address - Street 1:5338 KIAMESHA WAY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1008
Practice Address - Country:US
Practice Address - Phone:480-510-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
07339225A00000X
TX78243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist