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General NPI Number Information
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NPI Number | 1144944257
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Entity Type | Organization
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Legal Business Name | MACKENZIE MENTAL HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 5600 S WILLOW DR
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City | HOUSTON
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State | TX
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Zip | 77035-4713
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Country | US
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Telephone | 833-442-0247
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Fax | 713-583-0004
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Provider Business Mailing Address
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Address Line | 5600 S WILLOW DR
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City | HOUSTON
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State | TX
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Zip | 77035-4713
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Country | US
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Telephone | 833-442-0247
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Fax | 713-583-0004
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHAVON WILLIAMS
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Credential | LPC
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Telephone | 832-901-4846
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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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