Healthcare Provider Details

I. General information

NPI: 1255207288
Provider Name (Legal Business Name): MACKENZIE MCFANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24422 AVENIDA DE LA CARLOTA
LAGUNA HILLS CA
92653-3636
US

IV. Provider business mailing address

19744 BEACH BLVD STE 322
HUNTINGTON BEACH CA
92648-2988
US

V. Phone/Fax

Practice location:
  • Phone: 800-801-9833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT156668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: