Provider Demographics
NPI:1225735251
Name:WEILER, MACKENZIE A (LAC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:A
Last Name:WEILER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 E VIA LINDA STE 218A
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5317
Mailing Address - Country:US
Mailing Address - Phone:602-540-0441
Mailing Address - Fax:
Practice Address - Street 1:10245 E VIA LINDA STE 218A
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5317
Practice Address - Country:US
Practice Address - Phone:602-540-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ06-2022OtherASU - COLLEGE OF INTEGRATED SCIENCES