Provider Demographics
NPI:1720593106
Name:OUAKNINE, IZABELLA (LMFT)
Entity Type:Individual
Prefix:
First Name:IZABELLA
Middle Name:
Last Name:OUAKNINE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BELLA
Other - Middle Name:
Other - Last Name:OUAKNINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:981 E ROGGEN WAY
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8037
Mailing Address - Country:US
Mailing Address - Phone:408-712-5471
Mailing Address - Fax:
Practice Address - Street 1:4790 TABLE MESA DR STE 108
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5660
Practice Address - Country:US
Practice Address - Phone:720-773-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist