Provider Demographics
NPI:1952617961
Name:NWANEBU, LEONARD NWADIOHA
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:NWADIOHA
Last Name:NWANEBU
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 1:6804 NW 135TH CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-5922
Mailing Address - Country:US
Mailing Address - Phone:405-812-6618
Mailing Address - Fax:
Practice Address - Street 1:6804 NW 135TH CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-5922
Practice Address - Country:US
Practice Address - Phone:405-812-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional