=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063838597
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCKENZIE & ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2014
-----------------------------------------------------
Last Update Date | 03/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 N MAIN ST SUITE 303
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67202-1525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-351-7644
-----------------------------------------------------
Fax | 316-351-7689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 N MAIN ST SUITE 303
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67202-1525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-351-7644
-----------------------------------------------------
Fax | 316-351-7689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST/OWNER
-----------------------------------------------------
Name | MR. MICHEAL C. MCKENZIE
-----------------------------------------------------
Credential | M.S., L.C.M.F.T.
-----------------------------------------------------
Telephone | 316-351-7644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 859
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------