Provider Demographics
NPI:1073392668
Name:OKPARA, IKECHI
Entity type:Individual
Prefix:
First Name:IKECHI
Middle Name:
Last Name:OKPARA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 ZONAL AVE. BUILDING A, SUITE 318
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1317
Mailing Address - Country:US
Mailing Address - Phone:213-289-4100
Mailing Address - Fax:855-638-8801
Practice Address - Street 1:1774 ZONAL AVE STE 318
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1063
Practice Address - Country:US
Practice Address - Phone:213-289-4100
Practice Address - Fax:855-638-8801
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18831101YP2500X
106S00000X
CA153426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician