Provider Demographics
NPI:1659037703
Name:LIBBETT, MAKENZIE
Entity Type:Individual
Prefix:MISS
First Name:MAKENZIE
Middle Name:
Last Name:LIBBETT
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 1:1827 SAINT ANN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-2843
Mailing Address - Country:US
Mailing Address - Phone:601-287-1702
Mailing Address - Fax:
Practice Address - Street 1:1827 SAINT ANN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70116-2843
Practice Address - Country:US
Practice Address - Phone:601-287-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician