Provider Demographics
NPI:1164196796
Name:EHRGOOD, MACKENZIE DAVID I
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:DAVID
Last Name:EHRGOOD
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FIELD LN
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7911
Mailing Address - Country:US
Mailing Address - Phone:717-538-0332
Mailing Address - Fax:
Practice Address - Street 1:27 FIELD LN
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7911
Practice Address - Country:US
Practice Address - Phone:717-538-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor