Provider Demographics
NPI:1245721000
Name:SULEIMAN-LONG, OLANREWAJU
Entity type:Individual
Prefix:
First Name:OLANREWAJU
Middle Name:
Last Name:SULEIMAN-LONG
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 1:15835 FOOTHILL FARMS LOOP APT 2312
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3263
Mailing Address - Country:US
Mailing Address - Phone:405-694-1440
Mailing Address - Fax:
Practice Address - Street 1:15835 FOOTHILL FARMS LOOP APT 2312
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3263
Practice Address - Country:US
Practice Address - Phone:140-569-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-28
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85119101YP2500X
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor