Healthcare Provider Details

I. General information

NPI: 1992411540
Provider Name (Legal Business Name): MACKENZIE ANNE GABRESKI LPC, LCPC, LIMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 FENWICK AVE
FORT WALTON BEACH FL
32547-4952
US

IV. Provider business mailing address

1625 FENWICK AVE
FORT WALTON BEACH FL
32547-4952
US

V. Phone/Fax

Practice location:
  • Phone: 303-815-8515
  • Fax:
Mailing address:
  • Phone: 720-336-3249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0018837
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number03572
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC.0018837
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0018837
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2025027925
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27178
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3577
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: