Provider Demographics
NPI:1255197281
Name:DOMIA, OSHIOKHA
Entity type:Individual
Prefix:
First Name:OSHIOKHA
Middle Name:
Last Name:DOMIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6777 SOMMERALL DR APT 1317
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7004
Mailing Address - Country:US
Mailing Address - Phone:903-520-9471
Mailing Address - Fax:
Practice Address - Street 1:10242 GREENHOUSE RD STE 401
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1827
Practice Address - Country:US
Practice Address - Phone:281-758-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23277967103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty