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General NPI Number Information
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NPI Number | 1215449285
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Entity Type | Individual
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Provider Name | MCKENZIE MARIE ESPLIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 2406 CYPRESS GLEN DR STE 101
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-4609
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Country | US
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Telephone | 801-210-1184
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Fax |
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Provider Business Mailing Address
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Address Line | 29754 CHAPEL CHASE DR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33545-3016
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Country | US
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Telephone | 435-215-5991
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9812989-3501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18776
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License Number State | FL
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