=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124728217
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MACKEY FAMILY THERAPY AND WELLNESS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2023
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 422 N REDINGTON ST
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93230-4452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-423-4042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 942
-----------------------------------------------------
City | HANFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93232-0942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-423-4042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/LMFT
-----------------------------------------------------
Name | MRS. AARYN CORINNE MACKEY
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 559-423-4042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------