Provider Demographics
NPI:1568559110
Name:MCKENZIE, STACY ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 SEGO LILY DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4435
Mailing Address - Country:US
Mailing Address - Phone:801-942-3603
Mailing Address - Fax:
Practice Address - Street 1:5800 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1359
Practice Address - Country:US
Practice Address - Phone:801-272-9980
Practice Address - Fax:801-272-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5153757-6004101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional