Provider Demographics
NPI:1962958975
Name:EWEGBEJE, JOSEPH (LPC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:EWEGBEJE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 MULE DEER DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4554
Mailing Address - Country:US
Mailing Address - Phone:817-532-8326
Mailing Address - Fax:
Practice Address - Street 1:1901 CENTRAL DR
Practice Address - Street 2:SUITE 603
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5869
Practice Address - Country:US
Practice Address - Phone:817-532-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional