Provider Demographics
NPI:1083625636
Name:MCKENZIE, TIFFANI DANAE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANI
Middle Name:DANAE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10204 ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7666
Mailing Address - Country:US
Mailing Address - Phone:405-630-0025
Mailing Address - Fax:
Practice Address - Street 1:5106 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2032
Practice Address - Country:US
Practice Address - Phone:405-887-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3969101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional