Healthcare Provider Details

I. General information

NPI: 1609271659
Provider Name (Legal Business Name): ROSS & MACKENZIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2014
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N LITCHFIELD RD STE 105
GOODYEAR AZ
85338-1256
US

IV. Provider business mailing address

319 N LITCHFIELD RD SUITE 105
GOODYEAR AZ
85338-1256
US

V. Phone/Fax

Practice location:
  • Phone: 623-224-1162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. WAYNE M MACKENZIE SR.
Title or Position: CEO
Credential: PMHNP-BC
Phone: 623-224-1162