Provider Demographics
NPI:1942016829
Name:ACHA, ENOSADEBA OMOSIGHO
Entity type:Individual
Prefix:
First Name:ENOSADEBA
Middle Name:OMOSIGHO
Last Name:ACHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 FRY RD STE 701
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7850
Mailing Address - Country:US
Mailing Address - Phone:713-806-5430
Mailing Address - Fax:
Practice Address - Street 1:8118 FRY RD STE 701
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7850
Practice Address - Country:US
Practice Address - Phone:713-806-5430
Practice Address - Fax:281-815-8537
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty