Provider Demographics
NPI:1063303022
Name:MINTAH, KOJO (PHD)
Entity type:Individual
Prefix:DR
First Name:KOJO
Middle Name:
Last Name:MINTAH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:KOJO
Other - Middle Name:
Other - Last Name:MINTAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2914 LA FONTAINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2492
Mailing Address - Country:US
Mailing Address - Phone:281-850-4453
Mailing Address - Fax:713-513-5194
Practice Address - Street 1:2211 NORFOLK ST STE 455
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4119
Practice Address - Country:US
Practice Address - Phone:832-278-1849
Practice Address - Fax:713-513-5194
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40203103G00000X, 103TC1900X, 103TC2200X, 103TM1800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities