Healthcare Provider Details

I. General information

NPI: 1184438301
Provider Name (Legal Business Name): MACKENZIE KAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

224 COLUMBUS RD
ATHENS OH
45701-1334
US

IV. Provider business mailing address

224 COLUMBUS RD
ATHENS OH
45701-1334
US

V. Phone/Fax

Practice location:
  • Phone: 740-592-6724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2504149-TRNE
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCMS
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberOCPSA.162162
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberQMHS3
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: