Provider Demographics
NPI:1235947060
Name:OLOBA, VANESSA URSILLE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:URSILLE
Last Name:OLOBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5764
Mailing Address - Country:US
Mailing Address - Phone:405-965-5269
Mailing Address - Fax:
Practice Address - Street 1:901 S BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5764
Practice Address - Country:US
Practice Address - Phone:405-965-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical