Provider Demographics
NPI:1356861538
Name:O'MEALEY, MACKENZIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MACKENZIE
Middle Name:
Last Name:O'MEALEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 CEDAR LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7813
Mailing Address - Country:US
Mailing Address - Phone:405-602-9413
Mailing Address - Fax:405-652-0307
Practice Address - Street 1:917 CEDAR LAKE BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-7813
Practice Address - Country:US
Practice Address - Phone:405-602-9413
Practice Address - Fax:405-652-0307
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK7633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200716670AMedicaid