Provider Demographics
NPI:1063095065
Name:IFABIYI, OPEOLUWA GBEMISOLA (MSW)
Entity type:Individual
Prefix:
First Name:OPEOLUWA
Middle Name:GBEMISOLA
Last Name:IFABIYI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E 17TH ST UNIT 402
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1840
Mailing Address - Country:US
Mailing Address - Phone:615-275-9143
Mailing Address - Fax:
Practice Address - Street 1:1515 N POST RD # A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4213
Practice Address - Country:US
Practice Address - Phone:317-282-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health