Healthcare Provider Details

I. General information

NPI: 1922928621
Provider Name (Legal Business Name): MACKENZIE LYN HAVERFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W. BROADWAY
THOMAS OK
73669
US

IV. Provider business mailing address

PO BOX 99
THOMAS OK
73669-0099
US

V. Phone/Fax

Practice location:
  • Phone: 580-661-3488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number434244
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: