Active NPI
Ezekiel L Oduola, LCSW
- Clinical Social Worker
- Houston, TX
National Provider Identifier
1922079045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 16882
- Practice address
- 4411 Dacoma St
Houston, TX 77092-8611 - Phone
- (713) 686-9194
- Fax
- (713) 686-9413
- NPI assigned
- Jan 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 16882 | TX | Primary |
Addresses
Primary practice location
4411 Dacoma St
Houston, TX 77092-8611
Mailing address
101 Feu Follet Rd Ste 100
Lafayette, LA 70508-4234
Phone (713) 686-9194
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 117147203 | Medicaid | TX |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16882 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shine Medical Providers PC | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651017600000",
"number": "1922079045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 FEU FOLLET RD STE 100",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705084234",
"telephone_number": "713-686-9194",
"fax_number": "713-686-9413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4411 DACOMA ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770928611",
"telephone_number": "713-686-9194",
"fax_number": "713-686-9413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODUOLA",
"first_name": "EZEKIEL",
"middle_name": "L",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-27",
"last_updated": "2022-04-27",
"certification_date": "2022-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "16882",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "117147203",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.