Provider Demographics
NPI:1962025114
Name:MCKENZIE, CANDACE (LMHC L60304682)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LMHC L60304682
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 SIDNEY AVE APT 3-112
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2462
Mailing Address - Country:US
Mailing Address - Phone:425-466-8207
Mailing Address - Fax:
Practice Address - Street 1:2564 CASCADES PASS BLVD
Practice Address - Street 2:THE LANDINGS BLDG. 779
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312
Practice Address - Country:US
Practice Address - Phone:360-476-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL60304682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health