Provider Demographics
NPI:1801653589
Name:THOMSON, MAKENZIE (LLPC)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:THOMSON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 MONUMENT LN
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2701
Mailing Address - Country:US
Mailing Address - Phone:248-872-3662
Mailing Address - Fax:
Practice Address - Street 1:1203 N MILFORD RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1033
Practice Address - Country:US
Practice Address - Phone:248-717-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023530APP24101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor