Healthcare Provider Details

I. General information

NPI: 1043842669
Provider Name (Legal Business Name): MS. CHRYSTAL JOY MACKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COHASSET RD STE 185
CHICO CA
95926-2460
US

IV. Provider business mailing address

PO BOX 1674
MAGALIA CA
95954-1674
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2810
  • Fax:
Mailing address:
  • Phone: 720-949-5524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: