Provider Demographics
NPI:1417596925
Name:DAVIDSON, MACKENZIE M (BA)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:M
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:WELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 W SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3627
Mailing Address - Country:US
Mailing Address - Phone:509-747-8224
Mailing Address - Fax:509-747-0609
Practice Address - Street 1:210 W SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3627
Practice Address - Country:US
Practice Address - Phone:509-747-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor