Healthcare Provider Details

I. General information

NPI: 1265703821
Provider Name (Legal Business Name): MARY E MCKENZIE-NASON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CARNEGIE AVE
CLEVELAND OH
44115-2641
US

IV. Provider business mailing address

6802 W SNOWVILLE RD STE B
BRECKSVILLE OH
44141-3296
US

V. Phone/Fax

Practice location:
  • Phone: 440-856-6955
  • Fax: 440-260-8576
Mailing address:
  • Phone: 440-276-0266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0900322
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0900322
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: