Provider Demographics
NPI:1831541168
Name:KERBER, MACKENZIE LEA (LPCC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LEA
Last Name:KERBER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:LEA
Other - Last Name:SHIELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:3464 WASHINGTON DR STE 115
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1453
Mailing Address - Country:US
Mailing Address - Phone:651-348-8551
Mailing Address - Fax:651-409-2029
Practice Address - Street 1:3464 WASHINGTON DR STE 115
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1453
Practice Address - Country:US
Practice Address - Phone:651-348-8551
Practice Address - Fax:651-409-2029
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health