Provider Demographics
NPI:1851670764
Name:MCKENZIE, MICHEAL CRAIG (LMFT-T)
Entity Type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:CRAIG
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:LMFT-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MAIN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-1525
Mailing Address - Country:US
Mailing Address - Phone:316-351-7644
Mailing Address - Fax:316-351-7689
Practice Address - Street 1:300 N MAIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-1525
Practice Address - Country:US
Practice Address - Phone:316-351-7644
Practice Address - Fax:316-351-7689
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1239K106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist