MEDICARE: MCKENZIE ERICSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1588381156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE ERICSON

Provider Business Mailing Address
First Line	:	2845 DULLES AVE
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2950
Country	:	US
Telephone Number	:	346-381-4963
Fax Number	:

Provider Business Practice Location Address
First Line	:	2845 DULLES AVE
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2950
Country	:	US
Telephone Number	:	346-381-4963
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	03/03/2026

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Directions to “ MCKENZIE ERICSON ” Practice Location

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