Provider Demographics
NPI:1487291910
Name:JOLAYEMI, OLUDAYO
Entity type:Individual
Prefix:
First Name:OLUDAYO
Middle Name:
Last Name:JOLAYEMI
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 1:600 STARLINDA CT APT C
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-8811
Mailing Address - Country:US
Mailing Address - Phone:281-704-1454
Mailing Address - Fax:682-205-2971
Practice Address - Street 1:3001 W 5TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-8901
Practice Address - Country:US
Practice Address - Phone:682-472-7771
Practice Address - Fax:682-205-2971
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX565401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical