Provider Demographics
NPI:1376576397
Name:MACKENZIE, HELENA J (LP, PHD)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:J
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:LP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 SELBY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2886
Mailing Address - Country:US
Mailing Address - Phone:612-345-0598
Mailing Address - Fax:
Practice Address - Street 1:366 SELBY AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2886
Practice Address - Country:US
Practice Address - Phone:612-345-0598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4407103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical