=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457265209
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MACKENLIE STOWERS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2026
-----------------------------------------------------
Last Update Date | 09/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1720 BEACON ST
-----------------------------------------------------
City | FORT WAYNE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46805-4749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-373-8015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10063 ARBOR PARK BLVD
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46774-0178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6851120167
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------