Provider Demographics
NPI:1043318249
Name:BURRELL, ISABELLA GAIL (LPC, NCGC1)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:GAIL
Last Name:BURRELL
Suffix:
Gender:F
Credentials:LPC, NCGC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 D ST SE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-8325
Mailing Address - Country:US
Mailing Address - Phone:918-576-3050
Mailing Address - Fax:
Practice Address - Street 1:1519 E STEVE OWENS BOULEVARD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354
Practice Address - Country:US
Practice Address - Phone:918-576-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor