Provider Demographics
NPI:1265781454
Name:ORIOLA-OTENAIKE, ELIZABETH O (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:O
Last Name:ORIOLA-OTENAIKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 OAKBEND TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3925
Mailing Address - Country:US
Mailing Address - Phone:817-422-3181
Mailing Address - Fax:817-423-7526
Practice Address - Street 1:6620 TRINITY HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3578
Practice Address - Country:US
Practice Address - Phone:817-346-9560
Practice Address - Fax:817-423-7526
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36054103T00000X, 103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent