Provider Demographics
NPI:1679241392
Name:MACKAY, MEGAN CARLENE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:CARLENE
Last Name:MACKAY
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 1:15927 W PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5854
Mailing Address - Country:US
Mailing Address - Phone:480-235-0736
Mailing Address - Fax:
Practice Address - Street 1:15927 W PARADISE LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5854
Practice Address - Country:US
Practice Address - Phone:480-235-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20176101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor