Provider Demographics
NPI:1154182087
Name:BAJOMO, MODUPE (LPC)
Entity type:Individual
Prefix:
First Name:MODUPE
Middle Name:
Last Name:BAJOMO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MODUPE
Other - Middle Name:MORENIKE
Other - Last Name:ORESANYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3701 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4963
Mailing Address - Country:US
Mailing Address - Phone:432-570-1084
Mailing Address - Fax:432-570-4069
Practice Address - Street 1:3701 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4963
Practice Address - Country:US
Practice Address - Phone:432-570-1084
Practice Address - Fax:432-570-4069
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85558101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional