Provider Demographics
NPI:1841716537
Name:MCKENZIE, BETH ANN (LMSW)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1430 STONE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1430 STONE MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3827
Practice Address - Country:US
Practice Address - Phone:319-230-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6558104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker