Provider Demographics
NPI:1295701696
Name:MCKENZIE, KEVIN JAMES (LCSW LMHP)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:LCSW LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 CHICAGO STREET
Mailing Address - Street 2:KEVIN J. MCKENZIE, LLC
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3533
Mailing Address - Country:US
Mailing Address - Phone:402-502-1024
Mailing Address - Fax:402-502-1555
Practice Address - Street 1:8021 CHICAGO ST
Practice Address - Street 2:KEVIN J. MCKENZIE, LLC
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3533
Practice Address - Country:US
Practice Address - Phone:402-502-1024
Practice Address - Fax:402-502-1555
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP2211101Y00000X
NELCSW995104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker