Provider Demographics
NPI:1699121004
Name:ONYIRIOHA, BUKOLA ANTHONIA (MA, LCDC-CI, LPC)
Entity type:Individual
Prefix:MRS
First Name:BUKOLA
Middle Name:ANTHONIA
Last Name:ONYIRIOHA
Suffix:
Gender:F
Credentials:MA, LCDC-CI, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23415 SANTINI ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2246
Mailing Address - Country:US
Mailing Address - Phone:832-371-5314
Mailing Address - Fax:281-581-9122
Practice Address - Street 1:23415 SANTINI ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2246
Practice Address - Country:US
Practice Address - Phone:832-371-5314
Practice Address - Fax:281-581-9122
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72317101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3637Medicaid
TX29300295Medicare Oscar/Certification
0422Medicare UPIN
TX3637Medicaid
1001Medicare PIN