=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508146002
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDACE DALE MCKENZIE LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2011
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16055 VENTURA BLVD STE 715
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-795-6537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1531 GENOA CT
-----------------------------------------------------
City | MYRTLE BEACH
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29579-5249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-795-6537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT83315
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------