Provider Demographics
NPI:1376390989
Name:MCKENZIE, EAVAN (MFTC)
Entity type:Individual
Prefix:
First Name:EAVAN
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 BRIGHTON BLVD APT 242
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3681
Mailing Address - Country:US
Mailing Address - Phone:541-517-8030
Mailing Address - Fax:
Practice Address - Street 1:9101 HARLAN ST STE 340
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2963
Practice Address - Country:US
Practice Address - Phone:720-815-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COKDC4M33ZY0012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist