Provider Demographics
NPI:1164103297
Name:MCMAHON, MAKENZIE (LMFT)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021-2300
Mailing Address - Country:US
Mailing Address - Phone:715-418-5561
Mailing Address - Fax:
Practice Address - Street 1:3535 PLYMOUTH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1393
Practice Address - Country:US
Practice Address - Phone:651-401-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health