Basic Information
| Provider Information | |||||||||
| NPI: | 1437468782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAKOUIE | ||||||||
| FirstName: | BAHBAH | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 155 | ||||||||
| Address2: | |||||||||
| City: | LAWNDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902600155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105920337 | ||||||||
| FaxNumber: | 2134022101 | ||||||||
| Practice Location | |||||||||
| Address1: | 14717 HAWTHORNE BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | LAWNDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902601580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103550432 | ||||||||
| FaxNumber: | 2134022101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 52448 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.