Provider Demographics
NPI:1164071536
Name:HARRIS, MACKENZIE RENE (LPC, LICDC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RENE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8963 KINGSRIDGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1623
Mailing Address - Country:US
Mailing Address - Phone:606-485-9323
Mailing Address - Fax:
Practice Address - Street 1:8963 KINGSRIDGE DR STE A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1623
Practice Address - Country:US
Practice Address - Phone:606-485-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHC.2204361101Y00000X
OHLICDC.162278101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)