Healthcare Provider Details

I. General information

NPI: 1770910366
Provider Name (Legal Business Name): MACKENZIE ELISE GUDDAT M.S., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W MEEKER ST 102
KENT WA
98032-5751
US

IV. Provider business mailing address

PO BOX 9572
SEATTLE WA
98109-0572
US

V. Phone/Fax

Practice location:
  • Phone: 888-232-0222
  • Fax:
Mailing address:
  • Phone: 888-232-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: