Provider Demographics
NPI:1568274868
Name:ONIBUDO, JENNIFER NICKOLE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICKOLE
Last Name:ONIBUDO
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 1:5017 CHITAL DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4259
Mailing Address - Country:US
Mailing Address - Phone:682-235-4836
Mailing Address - Fax:
Practice Address - Street 1:5017 CHITAL DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4259
Practice Address - Country:US
Practice Address - Phone:682-235-4836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional