Healthcare Provider Details

I. General information

NPI: 1982513354
Provider Name (Legal Business Name): MCKENZIE MARIE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENZIE MARIE O'CONNOR

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77564 COUNTRY CLUB DR STE 201
PALM DESERT CA
92211-0449
US

IV. Provider business mailing address

35423 TREVINO TRL
BEAUMONT CA
92223-6213
US

V. Phone/Fax

Practice location:
  • Phone: 760-702-0095
  • Fax:
Mailing address:
  • Phone: 909-831-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: