Provider Demographics
NPI:1740986553
Name:OKOYE, CHANTELLE EZINNE (LPC)
Entity type:Individual
Prefix:MS
First Name:CHANTELLE
Middle Name:EZINNE
Last Name:OKOYE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHANTELLE
Other - Middle Name:EZINNE
Other - Last Name:OGUADIMMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:28370 N GOLD LN
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-6059
Mailing Address - Country:US
Mailing Address - Phone:480-720-3393
Mailing Address - Fax:
Practice Address - Street 1:28370 N GOLD LN
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-6059
Practice Address - Country:US
Practice Address - Phone:480-720-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21227101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ171379Medicaid