Healthcare Provider Details

I. General information

NPI: 1922777655
Provider Name (Legal Business Name): MAKENZIE LEI HUGHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 US HIGHWAY 1 STE 104
ROCKLEDGE FL
32955-5704
US

IV. Provider business mailing address

5830 US HIGHWAY 1 STE 104
ROCKLEDGE FL
32955-5704
US

V. Phone/Fax

Practice location:
  • Phone: 321-426-7759
  • Fax:
Mailing address:
  • Phone: 661-902-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-15782
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-81321
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: