Provider Demographics
NPI:1184967663
Name:OKORONKWO, OLUCHI G
Entity type:Individual
Prefix:MS
First Name:OLUCHI
Middle Name:G
Last Name:OKORONKWO
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 1:1831 SKIPWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3032
Mailing Address - Country:US
Mailing Address - Phone:832-539-1249
Mailing Address - Fax:
Practice Address - Street 1:1831 SKIPWOOD DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3032
Practice Address - Country:US
Practice Address - Phone:832-539-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities