Provider Demographics
NPI:1346739380
Name:PARRY, MACKENZIE L (RBT-17-31537)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:L
Last Name:PARRY
Suffix:
Gender:F
Credentials:RBT-17-31537
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 DARLINGTON LN APT 15
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3206
Mailing Address - Country:US
Mailing Address - Phone:847-894-7347
Mailing Address - Fax:
Practice Address - Street 1:562 DARLINGTON LN APT 15
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3206
Practice Address - Country:US
Practice Address - Phone:847-894-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-17-31537106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician