Provider Demographics
NPI:1770973307
Name:OBIJEKWU, CHUDI A
Entity type:Individual
Prefix:MR
First Name:CHUDI
Middle Name:A
Last Name:OBIJEKWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 LINDELL RD STE D15
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1254
Mailing Address - Country:US
Mailing Address - Phone:702-943-0244
Mailing Address - Fax:702-943-0233
Practice Address - Street 1:3651 LINDELL RD STE D15
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-1254
Practice Address - Country:US
Practice Address - Phone:702-943-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0032101YM0800X
WYLPC-1519101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health