Provider Demographics
NPI:1407430465
Name:MCKENZIE, KATHERINE (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 1ST AVE N
Mailing Address - Street 2:#302
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2301
Mailing Address - Country:US
Mailing Address - Phone:206-659-6192
Mailing Address - Fax:
Practice Address - Street 1:2120 1ST AVE N
Practice Address - Street 2:#302
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2301
Practice Address - Country:US
Practice Address - Phone:206-659-6192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61159814101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC61159814OtherDEPARTMENT OF HEALTH