Individual provider Active NPI

Nicole Oduro Owusu, LCMFT

  • Marriage & Family Therapist
  • Gaithersburg, MD
National Provider Identifier
1013735026
Registry record updated Aug 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
203562 Issued in TX
Practice address
555 Quince Orchard Rd # 250
Gaithersburg, MD 20878-1437
Phone
(301) 276-7031
NPI assigned
Sep 30, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 203562 TX Primary
Marriage & Family Therapist 106H00000X LCM1094 MD

Addresses

Primary practice location

555 Quince Orchard Rd # 250
Gaithersburg, MD 20878-1437

Mailing address

555 Quince Orchard Rd
Gaithersburg, MD 20878-1437

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
203562TXMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mud Hook Mental Health PLLC CurrentSince Oct 6, 2024 Accepting new patients

Locations

2300 W FM 544
Ste 245
Wylie, TX 75098
Phone (214) 307-9546

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1013735026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 QUINCE ORCHARD RD",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208781437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 QUINCE ORCHARD RD # 250",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208781437",
            "telephone_number": "301-276-7031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODURO OWUSU",
        "first_name": "NICOLE",
        "credential": "LCMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-30",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "203562",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MD",
            "license": "LCM1094",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.