Provider Demographics
NPI:1649598103
Name:NNONAH, INNOCENT ONYEMA (MSC)
Entity type:Individual
Prefix:MR
First Name:INNOCENT
Middle Name:ONYEMA
Last Name:NNONAH
Suffix:
Gender:M
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 NW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5225
Mailing Address - Country:US
Mailing Address - Phone:405-789-3189
Mailing Address - Fax:405-604-0301
Practice Address - Street 1:2608 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-6616
Practice Address - Country:US
Practice Address - Phone:405-604-0300
Practice Address - Fax:405-604-0301
Is Sole Proprietor?:No
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NIL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health