Healthcare Provider Details

I. General information

NPI: 1750291308
Provider Name (Legal Business Name): MCKENZIE MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 BROWNS LAKE RD
JACKSON MI
49201-8376
US

IV. Provider business mailing address

111 SUSSEX PL
BROOKLYN MI
49230-8814
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-5200
  • Fax:
Mailing address:
  • Phone: 517-581-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPP0000001099566
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: