Provider Demographics
NPI:1144574690
Name:MCKENZIE, MEGHAN ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:ROSE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E. SANTA CLARA ST.
Mailing Address - Street 2:STE. 210
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-824-0982
Mailing Address - Fax:
Practice Address - Street 1:255 E. SANTA CLARA ST.
Practice Address - Street 2:STE. 210
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006
Practice Address - Country:US
Practice Address - Phone:626-824-0982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS2012567103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical