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General NPI Number Information
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NPI Number | 1417596925
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Entity Type | Individual
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Provider Name | MACKENZIE M BOLDEN M.S.
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Gender | Female
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 10000 NE 7TH AVE STE 403
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City | VANCOUVER
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State | WA
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Zip | 98685-4548
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Country | US
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Telephone | 360-952-3070
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Fax |
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Provider Business Mailing Address
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Address Line | 6509 SE CARLTON ST
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City | PORTLAND
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State | OR
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Zip | 97206-6627
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Country | US
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Telephone | 509-947-8327
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 61515373
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License Number State | WA
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