Provider Demographics
NPI:1760254643
Name:MCKENZIE, AMY (LMSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MCKENZIE
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 1:1106 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-9552
Mailing Address - Country:US
Mailing Address - Phone:601-258-4514
Mailing Address - Fax:
Practice Address - Street 1:309 LLEWELLYN AVE STE B
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2703
Practice Address - Country:US
Practice Address - Phone:601-258-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM10711104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker