Provider Demographics
NPI:1275207151
Name:WARD, MACKENZIE LEIGH
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LEIGH
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MACKENZIE
Other - Middle Name:LEIGH
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 D ST STE G
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5957
Mailing Address - Country:US
Mailing Address - Phone:530-742-7747
Mailing Address - Fax:
Practice Address - Street 1:201 D ST STE G
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5957
Practice Address - Country:US
Practice Address - Phone:530-742-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty