Individual
KEHINDE OLUSOGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4004 GREENWOOD WAY, MANSFIELD, TX 76063-5560
(817) 714-9823
Mailing address
4004 GREENWOOD WAY, MANSFIELD, TX 76063-5560
(817) 714-9823
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261QM0850X
—
TX
Enumeration date
04/20/2018
Last updated
09/14/2018
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