Provider Demographics
NPI:1679812713
Name:STUART, MACKENZIE MCGREGOR (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:MCGREGOR
Last Name:STUART
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6384
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-8184
Mailing Address - Country:US
Mailing Address - Phone:510-394-4679
Mailing Address - Fax:
Practice Address - Street 1:2329 SANTA CLARA AVE STE 202
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4521
Practice Address - Country:US
Practice Address - Phone:510-394-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 83491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health