Provider Demographics
NPI:1245450386
Name:EYO, EMMANUEL P (COUNSELOR)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:P
Last Name:EYO
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2502
Mailing Address - Country:US
Mailing Address - Phone:323-309-9064
Mailing Address - Fax:
Practice Address - Street 1:4108 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-2502
Practice Address - Country:US
Practice Address - Phone:323-309-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor