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General NPI Number Information
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NPI Number | 1396986709
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Entity Type | Individual
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Provider Name | BRENDA MCKENZIE MS, MED, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 531 BRYDEN AVE
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City | LEWISTON
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State | ID
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Zip | 83501-4438
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Country | US
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Telephone | 208-798-1646
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Fax | 208-798-5568
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Provider Business Mailing Address
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Address Line | 827 GRELLE AVE
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City | LEWISTON
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State | ID
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Zip | 83501-5209
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Country | US
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Telephone | 208-798-1646
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Fax | 208-798-5568
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-3998
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-5676
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License Number State | ID
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