Provider Demographics
NPI:1043896327
Name:LLANO, MCKENZIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ELIZABETH
Last Name:LLANO
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 1:10925 LAMPIONE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3924
Mailing Address - Country:US
Mailing Address - Phone:925-719-3131
Mailing Address - Fax:
Practice Address - Street 1:10925 LAMPIONE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-3924
Practice Address - Country:US
Practice Address - Phone:925-719-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT-20-144187OtherRBT CERTIFICATION