Basic Information
| Provider Information | |||||||||
| NPI: | 1518542208 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OKORO | ||||||||
| FirstName: | SHAIUANA | ||||||||
| MiddleName: | CARROLL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13215 AMBROSA DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770441543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322936034 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6315 GULFTON ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770811107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134574372 | ||||||||
| FaxNumber: | 7134570945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2021 | ||||||||
| LastUpdateDate: | 05/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 79321 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 79321 | 01 | TX | NBCC | OTHER |