Provider Demographics
NPI:1003675158
Name:STOCKING, MACKENZIE ANN
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ANN
Last Name:STOCKING
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 1:132 E BOXCAR LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-1500
Mailing Address - Country:US
Mailing Address - Phone:435-709-1172
Mailing Address - Fax:
Practice Address - Street 1:5937 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5254
Practice Address - Country:US
Practice Address - Phone:801-576-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health