Provider Demographics
NPI:1104001601
Name:MCKENZIE, WILLIAM LAWRENCE (BSPA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LAWRENCE
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:BSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N MONTEREY ST
Mailing Address - Street 2:#113
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1564
Mailing Address - Country:US
Mailing Address - Phone:323-423-7593
Mailing Address - Fax:
Practice Address - Street 1:800 N MONTEREY ST
Practice Address - Street 2:# 113
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-1564
Practice Address - Country:US
Practice Address - Phone:323-423-7593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health