Provider Demographics
NPI:1326642331
Name:SOBCZAK, MCKENZIE (TLLP)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:SOBCZAK
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2322
Mailing Address - Country:US
Mailing Address - Phone:989-292-3572
Mailing Address - Fax:989-292-3952
Practice Address - Street 1:323 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2322
Practice Address - Country:US
Practice Address - Phone:989-292-3572
Practice Address - Fax:989-292-3952
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009558103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical