Provider Demographics
NPI:1851736607
Name:MACKEY, JENNIFER K (LMSW, LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:MACKEY
Suffix:
Gender:F
Credentials:LMSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 S HILLSIDE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3602
Mailing Address - Country:US
Mailing Address - Phone:316-295-4800
Mailing Address - Fax:316-295-4811
Practice Address - Street 1:714 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3002
Practice Address - Country:US
Practice Address - Phone:316-295-4800
Practice Address - Fax:316-295-4811
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10534104100000X
KS665101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)