Provider Demographics
NPI:1295379097
Name:MCKENZIE, ELIZABETH BYERS
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BYERS
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S HILLCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-1632
Mailing Address - Country:US
Mailing Address - Phone:334-482-1174
Mailing Address - Fax:
Practice Address - Street 1:80 COLLEGE BLVD E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1343
Practice Address - Country:US
Practice Address - Phone:850-279-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19-99438106S00000X
AL1-23-69361103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician