Provider Demographics
NPI:1003104050
Name:MCKENZIE, MIA BELLE (LPC)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:BELLE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:BELLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:500 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-3341
Mailing Address - Country:US
Mailing Address - Phone:806-897-9735
Mailing Address - Fax:806-568-0299
Practice Address - Street 1:500 WEST AVE
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-3341
Practice Address - Country:US
Practice Address - Phone:806-897-9735
Practice Address - Fax:806-568-0299
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health