Provider Demographics
NPI:1285966069
Name:OKWUONU, IKE ALPHONSUS (LPC CANDIDATE)
Entity type:Individual
Prefix:MR
First Name:IKE
Middle Name:ALPHONSUS
Last Name:OKWUONU
Suffix:
Gender:M
Credentials:LPC CANDIDATE
Other - Prefix:MRS
Other - First Name:IMELDA
Other - Middle Name:CHINELO
Other - Last Name:OKWUONU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:16500 SUNNY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6743
Mailing Address - Country:US
Mailing Address - Phone:405-341-7804
Mailing Address - Fax:
Practice Address - Street 1:16500 SUNNY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-6743
Practice Address - Country:US
Practice Address - Phone:405-341-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1515Medicare PIN