Provider Demographics
NPI:1912207689
Name:MACKENZIE, TRACEY LEE (BST)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LEE
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:BST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 ARCATA WAY STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3381
Mailing Address - Country:US
Mailing Address - Phone:702-489-6318
Mailing Address - Fax:
Practice Address - Street 1:4224 ARCATA WAY STE A
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3381
Practice Address - Country:US
Practice Address - Phone:702-489-6318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health