Provider Demographics
NPI:1285238592
Name:KWOT, OKACH
Entity type:Individual
Prefix:
First Name:OKACH
Middle Name:
Last Name:KWOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12757 GERMANE AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-9628
Mailing Address - Country:US
Mailing Address - Phone:612-876-1185
Mailing Address - Fax:
Practice Address - Street 1:2104 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-6607
Practice Address - Country:US
Practice Address - Phone:612-295-2979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor