Provider Demographics
NPI:1922678309
Name:MCKENZIE, TRISTAN (MS)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9729 WOOD GREEN LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-7901
Mailing Address - Country:US
Mailing Address - Phone:901-626-4295
Mailing Address - Fax:
Practice Address - Street 1:2262 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3805
Practice Address - Country:US
Practice Address - Phone:901-753-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health