Provider Demographics
NPI:1184210536
Name:SEYI AMOSU, LLC
Entity type:Organization
Organization Name:SEYI AMOSU, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWASEYI
Authorized Official - Middle Name:OLOLADE
Authorized Official - Last Name:AMOSU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-799-7576
Mailing Address - Street 1:235 E PONCE DE LEON AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3452
Mailing Address - Country:US
Mailing Address - Phone:678-799-7576
Mailing Address - Fax:678-799-7576
Practice Address - Street 1:235 E PONCE DE LEON AVE STE 220
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3452
Practice Address - Country:US
Practice Address - Phone:678-799-7576
Practice Address - Fax:678-799-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty