Provider Demographics
NPI:1639863525
Name:GOTES, MAKENZIE ELAINE (BA)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:ELAINE
Last Name:GOTES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MASON
Other - Middle Name:LAIN
Other - Last Name:COLWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:SHADY POINT
Mailing Address - State:OK
Mailing Address - Zip Code:74956-0045
Mailing Address - Country:US
Mailing Address - Phone:918-649-7913
Mailing Address - Fax:
Practice Address - Street 1:1700 W ALBANY ST STE 400
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1474
Practice Address - Country:US
Practice Address - Phone:918-824-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator