Provider Demographics
NPI:1609480250
Name:ONYEMEM, SHANTERIA (CTRS, LPC)
Entity type:Individual
Prefix:MS
First Name:SHANTERIA
Middle Name:
Last Name:ONYEMEM
Suffix:
Gender:F
Credentials:CTRS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 S MAIN ST STE 4&8
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4731
Mailing Address - Country:US
Mailing Address - Phone:346-754-3490
Mailing Address - Fax:
Practice Address - Street 1:3811 GLADE HILL LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3244
Practice Address - Country:US
Practice Address - Phone:713-345-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65442225800000X
TX86422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist