Provider Demographics
NPI:1851619035
Name:MAKOWSKI, GAYLORD BRUCE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:GAYLORD
Middle Name:BRUCE
Last Name:MAKOWSKI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2694 SE TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-8749
Mailing Address - Country:US
Mailing Address - Phone:503-266-6108
Mailing Address - Fax:
Practice Address - Street 1:147 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-8749
Practice Address - Country:US
Practice Address - Phone:503-266-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0136106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist