Provider Demographics
NPI:1750102075
Name:MCKENZIE MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:MCKENZIE MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:458-205-8347
Mailing Address - Street 1:921 COUNTRY CLUB RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6039
Mailing Address - Country:US
Mailing Address - Phone:458-205-8347
Mailing Address - Fax:458-231-9744
Practice Address - Street 1:921 COUNTRY CLUB RD STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6039
Practice Address - Country:US
Practice Address - Phone:458-214-8745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty