Provider Demographics
NPI:1679384408
Name:ODILI, OBIAJURUM ANTHONIA (LPC-A)
Entity type:Individual
Prefix:
First Name:OBIAJURUM
Middle Name:ANTHONIA
Last Name:ODILI
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 SAM HOUSTON AVE APT 1222C
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-6664
Mailing Address - Country:US
Mailing Address - Phone:936-400-9191
Mailing Address - Fax:
Practice Address - Street 1:5020 SAM HOUSTON AVE APT 1222C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-6664
Practice Address - Country:US
Practice Address - Phone:936-400-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health