Individual
SAM OGUNTADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
3840 HULEN ST, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76107-7277
(817) 569-4300
Mailing address
PO BOX 2603, HTN, CLIENT ACCOUNTING, FORT WORTH, TX 76113-2603
(817) 569-4300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12595
TX
1041C0700X
Clinical Social Worker
31014
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8EBK56
BCBS
TX
Enumeration date
09/23/2011
Last updated
07/31/2015
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