Provider Demographics
NPI:1326361593
Name:MUWWAKKIL, LABEEB A
Entity Type:Individual
Prefix:MR
First Name:LABEEB
Middle Name:A
Last Name:MUWWAKKIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 N.E. 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA
Mailing Address - State:OKLAHOMA
Mailing Address - Zip Code:73117
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2504 N.E. 12TH STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73117-5219
Practice Address - Country:US
Practice Address - Phone:405-424-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK111OtherODMHSAS CASE MANAGEWMENT, RSS AND C-RSS