Provider Demographics
NPI:1366197063
Name:ODUMADE, ADEFOLAKE (LMSW)
Entity type:Individual
Prefix:
First Name:ADEFOLAKE
Middle Name:
Last Name:ODUMADE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ADEFOLAKE
Other - Middle Name:
Other - Last Name:BAMITEKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12337 JONES RD STE 200-12
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4893
Mailing Address - Country:US
Mailing Address - Phone:903-345-4545
Mailing Address - Fax:
Practice Address - Street 1:12337 JONES RD STE 200-12
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4893
Practice Address - Country:US
Practice Address - Phone:903-345-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX41461130OtherDRIVERS LICENSE