Provider Demographics
NPI:1952941155
Name:YEMI-ESE, OLUWAKEMI
Entity Type:Individual
Prefix:
First Name:OLUWAKEMI
Middle Name:
Last Name:YEMI-ESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEMI
Other - Middle Name:
Other - Last Name:YEMI-ESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12101 DESSAU RD APT 705
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754
Mailing Address - Country:US
Mailing Address - Phone:281-221-3022
Mailing Address - Fax:
Practice Address - Street 1:2717 RIO GRANDE STREET
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-522-1382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional