MEDICARE: MR. LABEEB A. MUWWAKKIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	111	OTHER	OK	ODMHSAS CASE MANAGEWMENT, RSS AND C-RSS

General Provider Information

NPI Number	:	1326361593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LABEEB A. MUWWAKKIL

Provider Business Mailing Address
First Line	:	2504 N.E. 12TH STREET
Second Line	:
City	:	OKLAHOMA
State	:	OKLAHOMA
Zip	:	73117
Country	:	UM
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2504 N.E. 12TH STREET
Second Line	:
City	:	OKLAHOMA
State	:	OK
Zip	:	73117-5219
Country	:	US
Telephone Number	:	405-424-6650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	03/02/2010

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