Healthcare Provider Details

I. General information

NPI: 1972478071
Provider Name (Legal Business Name): KATHRYNN MCKENZIE MS, BHP, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15820 N 35TH AVE STE 14
PHOENIX AZ
85053-7608
US

IV. Provider business mailing address

15820 N 35TH AVE STE 14
PHOENIX AZ
85053-7608
US

V. Phone/Fax

Practice location:
  • Phone: 868-662-0738
  • Fax:
Mailing address:
  • Phone: 866-207-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-24070
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: