Provider Demographics
NPI:1164078572
Name:SEWARD, MCKENZIE ELISE
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ELISE
Last Name:SEWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7304 NW 114TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2707
Mailing Address - Country:US
Mailing Address - Phone:405-818-8626
Mailing Address - Fax:
Practice Address - Street 1:2120 S BROADWAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4021
Practice Address - Country:US
Practice Address - Phone:405-582-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health