Provider Demographics
NPI:1114738739
Name:ISOYEVA, MARHABO B
Entity type:Individual
Prefix:
First Name:MARHABO
Middle Name:B
Last Name:ISOYEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 UNIVERSITY BLVD APT B8
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1659
Mailing Address - Country:US
Mailing Address - Phone:205-246-1174
Mailing Address - Fax:
Practice Address - Street 1:1701 UNIVERSITY BLVD
Practice Address - Street 2:APARTMENT B8
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:205-246-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-24-377592106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician