Provider Demographics
NPI:1700569845
Name:ABORISADE, TEMITOPE EMMANUEL (QMHP, PHD)
Entity Type:Individual
Prefix:
First Name:TEMITOPE
Middle Name:EMMANUEL
Last Name:ABORISADE
Suffix:
Gender:M
Credentials:QMHP, PHD
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NA
Mailing Address - Street 1:1316 STONEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3901
Mailing Address - Country:US
Mailing Address - Phone:667-383-5932
Mailing Address - Fax:
Practice Address - Street 1:714 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6010
Practice Address - Country:US
Practice Address - Phone:541-880-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling