Healthcare Provider Details

I. General information

NPI: 1104553015
Provider Name (Legal Business Name): MCKENZIE MINTON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENZIE LAWSON

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 BRIGHTS PIKE
MORRISTOWN TN
37814
US

IV. Provider business mailing address

PO BOX 32665
KNOXVILLE TN
37930-2665
US

V. Phone/Fax

Practice location:
  • Phone: 865-312-8220
  • Fax: 833-550-1727
Mailing address:
  • Phone: 865-312-8220
  • Fax: 833-550-1727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72850
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: