Provider Demographics
NPI:1457108144
Name:WILLIAMS, MCKENZIE TAYLOR
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:TAYLOR
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S HICKOK ST
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2317
Mailing Address - Country:US
Mailing Address - Phone:720-442-3532
Mailing Address - Fax:
Practice Address - Street 1:108 S HICKOK ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2317
Practice Address - Country:US
Practice Address - Phone:720-442-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician