Provider Demographics
NPI:1477212926
Name:GOHDES, MACKENZIE FAYE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:FAYE
Last Name:GOHDES
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SAINT ANDREWS CT STE 710
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-8815
Mailing Address - Country:US
Mailing Address - Phone:507-386-7121
Mailing Address - Fax:507-344-0690
Practice Address - Street 1:151 SAINT ANDREWS CT STE 710
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-8815
Practice Address - Country:US
Practice Address - Phone:507-386-7121
Practice Address - Fax:507-344-0690
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3092101YP2500X
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional