Provider Demographics
NPI:1780490367
Name:OKEMWENKHASE, UWAILA CINDY
Entity type:Individual
Prefix:
First Name:UWAILA
Middle Name:CINDY
Last Name:OKEMWENKHASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 WHITE ROCK
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5491
Mailing Address - Country:US
Mailing Address - Phone:214-609-0534
Mailing Address - Fax:
Practice Address - Street 1:2900 CANTON ST APT 325
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1688
Practice Address - Country:US
Practice Address - Phone:214-609-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional