Provider Demographics
NPI:1205843869
Name:MCKENZIE, LEZLIE LORRAINE (PMHCNS)
Entity Type:Individual
Prefix:MS
First Name:LEZLIE
Middle Name:LORRAINE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PMHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715A SKYLA CT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1480
Mailing Address - Country:US
Mailing Address - Phone:406-543-2883
Mailing Address - Fax:406-543-2734
Practice Address - Street 1:715A SKYLA CT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-543-2883
Practice Address - Fax:406-543-2734
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAPRN-LIC-99980364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT371741OtherBLUE CROSS BLUE SHIELD
MT371741OtherBLUE CROSS BLUE SHIELD