Provider Demographics
NPI:1508330606
Name:SHOWEMIMO, MODINAT OLUWATOSIN (LBSW)
Entity Type:Individual
Prefix:MS
First Name:MODINAT
Middle Name:OLUWATOSIN
Last Name:SHOWEMIMO
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-1717
Mailing Address - Country:US
Mailing Address - Phone:469-337-8723
Mailing Address - Fax:
Practice Address - Street 1:120 W MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4224
Practice Address - Country:US
Practice Address - Phone:469-337-8723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67117104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker