Provider Demographics
NPI:1710681341
Name:MILON, MACKENZIE (LMSW)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:MILON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 CANE RIDGE PKWY APT 422
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5173
Mailing Address - Country:US
Mailing Address - Phone:219-895-9275
Mailing Address - Fax:
Practice Address - Street 1:1113 MURFREESBORO RD STE 202
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1318
Practice Address - Country:US
Practice Address - Phone:615-790-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12936104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker