Provider Demographics
NPI:1649756230
Name:FARLEY, MACKENZIE LEA
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LEA
Last Name:FARLEY
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 1:7142 S 92ND EAST AVE # 301
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5310
Mailing Address - Country:US
Mailing Address - Phone:580-306-1128
Mailing Address - Fax:
Practice Address - Street 1:102 N DENVER AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-1806
Practice Address - Country:US
Practice Address - Phone:918-582-1200
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor