Provider Demographics
NPI:1770867608
Name:MACKEY, JONATHAN CHARLES (LCSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CHARLES
Last Name:MACKEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5285
Mailing Address - Country:US
Mailing Address - Phone:480-779-9050
Mailing Address - Fax:480-717-4025
Practice Address - Street 1:1835 W CHANDLER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5285
Practice Address - Country:US
Practice Address - Phone:480-779-9050
Practice Address - Fax:480-717-4025
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-138841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical