Provider Demographics
NPI:1679283709
Name:SALAU, TOFUNMI TAYO (MSIS, PSYD)
Entity type:Individual
Prefix:DR
First Name:TOFUNMI
Middle Name:TAYO
Last Name:SALAU
Suffix:
Gender:M
Credentials:MSIS, PSYD
Other - Prefix:MR
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:FOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSIS, PSYD
Mailing Address - Street 1:20180 PARK ROW DR UNIT 6004
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77491-1443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20180 PARK ROW DR UNIT 6004
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77491-1443
Practice Address - Country:US
Practice Address - Phone:832-753-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80328101Y00000X, 102L00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80328OtherLICENSE