Provider Demographics
NPI:1245685767
Name:CORTESE, MACKENZIE (MA, LAC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:CORTESE
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13460 N 94TH DR
Mailing Address - Street 2:SUITE K-3
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4835
Mailing Address - Country:US
Mailing Address - Phone:623-974-3333
Mailing Address - Fax:623-974-3390
Practice Address - Street 1:13460 N 94TH DR
Practice Address - Street 2:SUITE K-3
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4835
Practice Address - Country:US
Practice Address - Phone:623-974-3333
Practice Address - Fax:623-974-3390
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-15505101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor