Provider Demographics
NPI:1750920831
Name:JORDAN, MACKENZIE (LMHC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:SCHMUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:924 N MAGNOLIA AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3852
Mailing Address - Country:US
Mailing Address - Phone:321-345-7029
Mailing Address - Fax:
Practice Address - Street 1:924 N MAGNOLIA AVE STE 340
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3852
Practice Address - Country:US
Practice Address - Phone:321-345-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health