Basic Information
| Provider Information | |||||||||
| NPI: | 1558536458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAKWANGWALA | ||||||||
| FirstName: | ISABEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1222 10TH STREET, SUITE 211 | ||||||||
| Address2: | NORTHWEST CENTER FOR BEHAVIORAL HEALTH | ||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803385851 | ||||||||
| FaxNumber: | 5803386022 | ||||||||
| Practice Location | |||||||||
| Address1: | 5120 HWY 54 NE | ||||||||
| Address2: | NORTHWEST CENTER FOR BEHAVIORAL HEALTH | ||||||||
| City: | GUYMON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803385851 | ||||||||
| FaxNumber: | 5803386022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2008 | ||||||||
| LastUpdateDate: | 04/23/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.