Provider Demographics
NPI:1831908532
Name:FASIDI, OLUBUSAYO
Entity type:Individual
Prefix:
First Name:OLUBUSAYO
Middle Name:
Last Name:FASIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLUBUSAYO
Other - Middle Name:
Other - Last Name:FATOKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16507 GREAT OAKS HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1649
Mailing Address - Country:US
Mailing Address - Phone:832-866-4580
Mailing Address - Fax:
Practice Address - Street 1:16507 GREAT OAKS HOLLOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1649
Practice Address - Country:US
Practice Address - Phone:832-866-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health