Individual
MRS. ADEPEJU IBIRONKE FABORO OSHAUGHNESSY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.H.C, L.P.C.
Contact information
Practice address
44 BUCKTAIL AVE, PONTE VEDRA, FL 32081-6181
(405) 473-4945
Mailing address
44 BUCKTAIL AVE, PONTE VEDRA, FL 32081-6181
(405) 473-4945
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH16093
FL
101YP2500X
Professional Counselor
6063
OK
101YP2500X
Professional Counselor
81315
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200331240B
—
OK
Enumeration date
09/12/2010
Last updated
02/02/2022
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