Healthcare Provider Details

I. General information

NPI: 1063335420
Provider Name (Legal Business Name): MACKENZIE ZUMWALT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E 29TH ST STE 300
BRYAN TX
77802-2623
US

IV. Provider business mailing address

3566 W HIGHWAY 21
BRYAN TX
77803-1127
US

V. Phone/Fax

Practice location:
  • Phone: 979-436-0810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number95818
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: