Provider Demographics
NPI:1205424058
Name:YOUNG, MACKENZIE SUSANN
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:SUSANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MACKENZIE
Other - Middle Name:SUSANN
Other - Last Name:PROULX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:714 LOST LANE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303
Mailing Address - Country:US
Mailing Address - Phone:503-856-6252
Mailing Address - Fax:
Practice Address - Street 1:714 LOST LANE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303
Practice Address - Country:US
Practice Address - Phone:503-576-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health