Doctor Name: | IKENNA EMEGANO |
NPI Number: | 1013214600 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | B.A. |
License Number: | |
Business Practice Address: | 112 Easy Street Ct Edmond, OK - 730124527 |
Business Phone Number: | 4059191002 |
Business Fax Number: | |
Mailing Address: | 112 Easy Street Ct, EDMOND |
State: | OK |
Postal Code: | 730124527 |
Phone Number: | 4059191002 |
Fax Number: | |
NPI Enumeration Date: | 02/17/2011 |
NPI Last Update Date: | 02/17/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |