Healthcare Provider Details

I. General information

NPI: 1659998466
Provider Name (Legal Business Name): MACKENZIE T SORRELS BSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WALNUT ST
OWENSBORO KY
42301-2956
US

IV. Provider business mailing address

1925 WRIGHTS LANDING RD
OWENSBORO KY
42303-9566
US

V. Phone/Fax

Practice location:
  • Phone: 270-689-6800
  • Fax:
Mailing address:
  • Phone: 270-315-2599
  • 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: