Provider Demographics
NPI:1053074005
Name:FOX, MACKENZIE (LPC-MHSP (TEMP))
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:LPC-MHSP (TEMP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 ELLIOTT AVE APT 760
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2575
Mailing Address - Country:US
Mailing Address - Phone:615-405-1426
Mailing Address - Fax:
Practice Address - Street 1:1101 17TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2203
Practice Address - Country:US
Practice Address - Phone:615-405-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5574101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor