Provider Demographics
NPI:1811513450
Name:MCKENZIE-PLEZ, ANTWAN
Entity type:Individual
Prefix:
First Name:ANTWAN
Middle Name:
Last Name:MCKENZIE-PLEZ
Suffix:
Gender:M
Credentials:
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 1298
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33061-1298
Mailing Address - Country:US
Mailing Address - Phone:786-260-3520
Mailing Address - Fax:954-697-0980
Practice Address - Street 1:800 NE 62ND ST STE 406
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3522
Practice Address - Country:US
Practice Address - Phone:954-412-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health