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General NPI Number Information
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NPI Number | 1114859345
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Entity Type | Individual
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Provider Name | MACKENZIE TYLER BIRD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2026
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Last Update Date | 06/02/2026
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Provider Practice Location Address
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Address Line | 4343 PAN AMERICAN FWY NE STE 221
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-6834
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Country | US
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Telephone | 505-421-0814
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Fax |
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Provider Business Mailing Address
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Address Line | 6948 TOPEKA HILLS DR NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-8628
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Country | US
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Telephone | 575-302-3883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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