Provider Demographics
NPI:1346043445
Name:OBASEKI, NOSAZENA
Entity type:Individual
Prefix:
First Name:NOSAZENA
Middle Name:
Last Name:OBASEKI
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 1:1550 PLYMOUTH RD APT 9
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1748
Mailing Address - Country:US
Mailing Address - Phone:734-239-1579
Mailing Address - Fax:
Practice Address - Street 1:1550 PLYMOUTH RD APT 9
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1748
Practice Address - Country:US
Practice Address - Phone:734-239-1579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009372103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical