Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 15880 | TX |
NPI | 1003104050 |
---|---|
Provider Name | Mia Belle Mckenzie |
First Address | Levelland, TX 79336-3341 |
Second Address | Levelland, TX 79336-3341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 12/07/2011 |