Healthcare Provider Details

I. General information

NPI: 1215864665
Provider Name (Legal Business Name): MCKENZIE LENAE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 RIVER ST
WALTHAM MA
02453-5476
US

IV. Provider business mailing address

2009 PR LYONS AVE.
CLOVIS NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 781-891-0555
  • Fax:
Mailing address:
  • Phone: 575-329-2165
  • 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: