Provider Demographics
NPI:1124321179
Name:CHUKWUMA, MARY
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:CHUKWUMA
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 1:1812 FOXFIRE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6202
Mailing Address - Country:US
Mailing Address - Phone:405-315-1357
Mailing Address - Fax:
Practice Address - Street 1:1812 FOXFIRE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6202
Practice Address - Country:US
Practice Address - Phone:405-315-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health