Provider Demographics
NPI:1689561524
Name:HARTLEY, MCKENZIE NICOLE
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:NICOLE
Last Name:HARTLEY
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:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:SOAP LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98851-0134
Mailing Address - Country:US
Mailing Address - Phone:509-492-1096
Mailing Address - Fax:
Practice Address - Street 1:2333 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-4656
Practice Address - Country:US
Practice Address - Phone:360-472-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604529709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health