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NPI Code Detail

MEDICARE: MAKENZIE RAE CLEVINGER MFTC, CACII

MEDICARE:   MAKENZIE RAE CLEVINGER  MFTC, CACII
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
1101YA0400XAddiction (Substance Use Disorder) Counselor7491CO
2101YM0800XMental Health CounselorMFTC.0013460CO

General Provider Information

NPI Number : 1902173875
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKENZIE RAE CLEVINGER MFTC, CACII
Provider Business Mailing Address
First Line : PO BOX 371674
Second Line :
City : DENVER
State : CO
Zip : 80237-5674
Country : US
Telephone Number : 720-705-5026
Fax Number :
Provider Business Practice Location Address
First Line : 1724 N GILPIN ST
Second Line :
City : DENVER
State : CO
Zip : 80218-1206
Country : US
Telephone Number : 720-705-5026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2011
Last Update Date : 06/16/2015

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Directions to “ MAKENZIE RAE CLEVINGER MFTC, CACII” Practice Location

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