Healthcare Provider Details

I. General information

NPI: 1134084551
Provider Name (Legal Business Name): MAKENZIE MOORE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD APT 203
BATON ROUGE LA
70808-4375
US

IV. Provider business mailing address

1509 GOVERNMENT ST APT 203
BATON ROUGE LA
70802-4088
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-6565
  • Fax:
Mailing address:
  • Phone: 316-207-0628
  • Fax: 316-207-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number19438
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: