Provider Demographics
NPI:1508459272
Name:TERRELL, MACKENZIE RACHEL
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RACHEL
Last Name:TERRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MILLERS DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7099
Mailing Address - Country:US
Mailing Address - Phone:502-921-3306
Mailing Address - Fax:
Practice Address - Street 1:1106 TUNNEL HILL RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8026
Practice Address - Country:US
Practice Address - Phone:270-765-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY290283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
199700OtherPERSONAL