Provider Demographics
NPI:1205356961
Name:BOSSERT, MCKENZIE E (QP, MA, LCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:E
Last Name:BOSSERT
Suffix:
Gender:F
Credentials:QP, MA, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CANDUN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-6411
Mailing Address - Country:US
Mailing Address - Phone:919-261-6099
Mailing Address - Fax:
Practice Address - Street 1:2201 CANDUN DR STE 101
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-6411
Practice Address - Country:US
Practice Address - Phone:919-359-0669
Practice Address - Fax:919-243-1879
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12828101YP2500X
NCA12828101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional