Provider Demographics
NPI:1770910366
Name:GUDDAT, MACKENZIE ELISE (MS, LMHC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ELISE
Last Name:GUDDAT
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9572
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-0572
Mailing Address - Country:US
Mailing Address - Phone:888-232-0222
Mailing Address - Fax:
Practice Address - Street 1:1103 W MEEKER ST
Practice Address - Street 2:102
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5751
Practice Address - Country:US
Practice Address - Phone:888-232-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health