Provider Demographics
NPI:1477235273
Name:MACKENZIE, ALLISON I (CMT, CHT, NLP, TLTP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:I
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:CMT, CHT, NLP, TLTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2150
Mailing Address - Country:US
Mailing Address - Phone:310-600-4677
Mailing Address - Fax:
Practice Address - Street 1:232 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4309
Practice Address - Country:US
Practice Address - Phone:424-405-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH38358171400000X
CA43694225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty